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Tan MY, Wu S, Zhu SX, Jiang LH. Association between exposure to organophosphorus pesticide and suicidal ideation among U.S. adults: A population-based study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 281:116572. [PMID: 38896903 DOI: 10.1016/j.ecoenv.2024.116572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE This study aims to investigate the potential link between exposure to organophosphorus pesticides (OPPs) and suicidal ideation (SI) among adults. METHODS This study encompassed four cycles of the National Health and Nutrition Examination Survey (NHANES), involving 5244 participants aged 20 and above. SI was assessed using the Patient Health Questionnaire-9. The levels of exposure to OPPs were estimated by analyzing concentrations of OPP metabolites in urine samples. Multivariate logistic regression models were used to explore the association between exposure to each OPP and SI. Stratified analyses and interaction tests were conducted across various groups, including pairwise combinations of gender and age, as well as body mass index, smoking status, hypertension, and diabetes. Weighted Quantile Sum (WQS) regression and Bayesian Kernel Machine Regression (BKMR) models were applied to assess the cumulative impact of exposure to the four OPPs on SI, along with their respective contributions. Additionally, the potential interactions among these four OPPs were evaluated. RESULTS Multivariate logistic regression revealed that only dimethylthiophosphate (DMTP) among OPPs demonstrated a statistically significant positive association with SI [OR: 1.18; 95 % CI: 1.02-1.37]. Stratified analyses indicated that the influence of OPPs on SI was particularly pronounced in young and older men. The WQS regression analysis revealed a statistically significant association between the mixed metabolites of OPPs and SI [OR = 1.10, 95 % CI: 1.04-1.16], with DMTP (weighted 0.63) contributing the most. Furthermore, the BKMR model supported a positive trend in the overall impact of these OPP metabolites on SI, displaying notable individual exposure-response relationships for DMTP (PIP: 0.77). CONCLUSIONS Our study suggests an association between exposure to DMTP and an increased risk of SI. Specifically, young adult males and older males appear particularly susceptible to the effects of OPP exposure.
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Affiliation(s)
- Mo-Yao Tan
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, Sichuan, China
| | - Shan Wu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Si-Xuan Zhu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Li-Hai Jiang
- Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, Sichuan, China.
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Terpstra SE, Hoogervorst LA, van der Velde JH, Mutsert RD, van de Stadt LA, Rosendaal FR, Kloppenburg M. Validation of the SQUASH physical activity questionnaire using accelerometry: The NEO study. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100462. [PMID: 38577551 PMCID: PMC10992721 DOI: 10.1016/j.ocarto.2024.100462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
Objective To investigate the construct validity of the SQUASH (Short QUestionnaire to ASsess Health-enhancing physical activity). Design This is a cross-sectional analysis using baseline measurements from middle-aged participants in the Netherlands Epidemiology of Obesity (NEO) study. The SQUASH consists of questions on eleven physical activities investigating days per week, average duration per day and intensity, leading to a summed score in Metabolic Equivalent of Task hours (MET h) per week. To assess convergent validity, a Spearman's rank correlation between SQUASH and ActiHeart was calculated. To assess extreme group validity, three groups expected to differ in SQUASH total physical activity outcome were compared. For discriminative validity, a Spearman's rank correlation between SQUASH physical activity and participant height was investigated. Results SQUASH data were available for 6550 participants (mean age 56 years, 44% men, mean BMI 26.3, 15% with knee OA, 13% with hand OA). Median physical activity (interquartile range) was 118 (76; 154) MET h/week according to SQUASH and 75 (58; 99) according to ActiHeart. Convergent validity was weak (rho = 0.20). For all three extreme group comparisons, a statistically significant difference was present. Discriminative validity was present (rho = 0.01). Compared with the reference quintile, those with a discrepancy SQUASH > ActiHeart and SQUASH < ActiHeart were relatively younger and more often male. Conclusions The construct validity of the SQUASH seems sub-optimal. Physical activity reported by the SQUASH was generally higher than reported by ActiHeart. Whether the differences between SQUASH and ActiHeart are e.g. due to different underlying domains, limitations to our study, or reflect true differences needs further investigation.
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Affiliation(s)
- Sietse E.S. Terpstra
- Department of Rheumatology, Leiden University Medical Center, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | - Lotje A. Hoogervorst
- Department of Orthopaedics, Leiden University Medical Center, the Netherlands
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | | | - Frits R. Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
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Wu Z, Bao L, Wang H, Zheng J, Chen Y, Wang W, Qiu D. Association between weight-adjusted waist index and serum total testosterone in males aged 6-19 years in the United States: Data from NHANES 2013-2016. Heliyon 2024; 10:e27520. [PMID: 38496858 PMCID: PMC10944222 DOI: 10.1016/j.heliyon.2024.e27520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 02/24/2024] [Accepted: 03/01/2024] [Indexed: 03/19/2024] Open
Abstract
Objective This study aimed to estimate the association between weight-adjusted waist index and serum total testosterone (sTT) in males aged 6-19 years in the United States. Methods A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016. sTT was considered as the response variable, and weight-adjusted waist circumference index (WWI) as the independent variable. Multiple linear regression was performed to estimate the association between the two variables, and subgroup analysis was performed to identify sensitive cohorts. Smoothing curve fitting and threshold effects analysis was carried out to assess possible nonlinear relationships between WWI and sTT. Results The study included 4207 participants. The mean value of sTT (117.93 ng/dl) was used as the grouping basis, with 1066 participants having serum total testosterone levels above the mean. A negative association was observed between WWI and sTT [beta coefficient (β) = -72.50, 95% confidence interval (CI): -79.45, -65.55], which decreased as WWI increased (P for trend<0.05). Subgroup analysis indicated a stronger negative correlation in late adolescent (16-19 years) males (β = -128.94, 95% CI: -146.75, -111.13). The smoothing curve fit analysis revealed a U-shaped curve relationship for the negative correlation between WWI and sTT. Threshold effect analysis suggested a significant change when WWI exceeded 10.09 (β = -15.82, 95% CI: -24.11, -7.54), and stepwise threshold effect analysis indicated that this negative correlation became less stable when WWI exceeded 11.45 (β = -0.80, 95% CI: -9.15, 7.56). Conclusions Participants with higher WWI exhibited lower total testosterone levels, and a negative association was found between WWI and total testosterone, particularly in late adolescent males aged 16-19 years. Among males aged 6-19 years, caution should be exercised regarding the risk of lower testosterone levels associated with elevated WWI, particularly when WWI is below 10.09.
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Affiliation(s)
- Zhifei Wu
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Lingling Bao
- Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Haiyan Wang
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Jiajing Zheng
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Yu Chen
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Wenjuan Wang
- Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
| | - Dongkai Qiu
- Department of Pediatrics, Beilun District People's Hospital, Ningbo City, Zhejiang Province, PR China
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Klarenberg H, van der Velde JHPM, Peeters CFW, Dekkers IA, de Mutsert R, Jukema JW, Rosendaal FR, Leiner T, Froeling M, Jorstad H, Boekholdt SM, Strijkers GJ, Lamb HJ. Leisure time physical activity is associated with improved diastolic heart function and is partly mediated by unsupervised quantified metabolic health. BMJ Open Sport Exerc Med 2024; 10:e001778. [PMID: 38347856 PMCID: PMC10860076 DOI: 10.1136/bmjsem-2023-001778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/15/2024] Open
Abstract
Objectives To investigate the association between leisure time physical activity (LTPA) and MRI-based diastolic function and the mediating role of metabolic health. Methods This cross-sectional analysis comprised 901 participants (46% women, mean age (SD): 56 (6) years (The Netherlands, 2008-2012)). LTPA was assessed via questionnaire, quantified in metabolic equivalent of tasks (METs)-minutes per week and participants underwent abdominal and cardiovascular MRI. Confirmatory factor analysis was used to construct the metabolic load factor. Piecewise structural equation model with adjustments for confounders was used to determine associations between LTPA and diastolic function and the mediating effect of metabolic load. Results Significant differences in mitral early/late peak filling rate (E/A) ratio per SD of LTPA (men=1999, women=1870 MET-min/week) of 0.18, (95% CI= 0.03 to 0.33, p=0.021) were observed in men, but not in women: -0.01 (-0.01 to 0.34, p=0.058). Difference in deceleration time of mitral early filling (E-DT) was 0.13 (0.01 to 0.24, p=0.030) in men and 0.17 (0.05 to 0.28, p=0.005) in women. Metabolic load, including MRI-based visceral and subcutaneous adipose tissue, fasting glucose, high-density lipoprotein cholesterol and triglycerides, mediated these associations as follows: E/A-ratio of 0.030 (0.000 to 0.067, 19% mediated, p=0.047) in men but not in women: 0.058 (0.027 to 0.089, p<0.001) and E-DT not in men 0.004 (-0.012 to 0.021, p=0.602) but did in women 0.044 (0.013 to 0.057, 27% mediated, p=0.006). Conclusions A larger amount of LTPA was associated with improved diastolic function where confirmatory factor analysis-based metabolic load partly mediated this effect. Future studies should assess whether improving indicators of metabolic load alongside LTPA will benefit healthy diastolic function even more.
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Affiliation(s)
- Hugo Klarenberg
- Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Carel FW Peeters
- Division of Mathematical & Statistical Methods – Biometris, Wageningen University & Research, Wageningen, The Netherlands
- Department of Epidemiology & Datascience, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tim Leiner
- Department of Radiology, UMC Utrecht, Utrecht, The Netherlands
| | | | - Harald Jorstad
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Han J, Li‐Gao R, de Mutsert R, Rosendaal FR, van Hylckama Vlieg A. Association between venous thromboembolism-associated genetic variants, coagulation factor levels, and thrombin generation potential. EJHAEM 2024; 5:47-54. [PMID: 38406509 PMCID: PMC10887265 DOI: 10.1002/jha2.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
Recently three large meta-analyses of genome-wide association studies for venous thromboembolism (VTE) identified over 130 genetic variants. However, mechanisms by which newly identified and therefore underexplored VTE-associated genetic variants influence VTE remain unclear. To elucidate the mechanism, we investigated the association between 61 newly identified VTE-associated genetic variants and the levels of coagulation factor (F) VIII, FIX, FXI, and fibrinogen as well as thrombin generation parameters (lag time, peak, endogenous thrombin potential, time-to-peak, and velocity), which are well-known biological traits associated with VTE. This study was conducted on 5341 participants of the Netherlands Epidemiology of Obesity study. The associations between VTE-associated genetic variants and coagulation factor levels and thrombin generation parameters were examined using linear regression analyses, adjusted for age, sex, body mass index, oral contraceptive use, hormone replacement therapy, and menopausal status. Of 61 genetic variants, 33 were associated with one or more of the coagulation factor levels and thrombin generation parameters. Following multiple testing corrections, five genetic variants remained significant, of which MAP1A rs55707100 exhibited the most robust association with thrombin generation parameters and FXI levels (β = -5.33%, 95% confidence interval: -8.44, -2.22). Our findings shed light on the underlying mechanisms by which these genetic variants influence the risk of VTE.
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Affiliation(s)
- Jihee Han
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Ruifang Li‐Gao
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Renée de Mutsert
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
| | - Frits R. Rosendaal
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenthe Netherlands
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Alblas G, Lamb HJ, Rosendaal FR, van Hoek B, Coenraad MJ, de Mutsert R. Prevalence of non-alcoholic fatty liver in the general Dutch population and in groups at increased risk. Nutr Metab Cardiovasc Dis 2023; 33:2497-2507. [PMID: 37798233 DOI: 10.1016/j.numecd.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIM Non-alcoholic fatty liver disease (NAFLD) is defined as a liver fat content ≥5.56%. It is of clinical interest to know the prevalence of NAFLD in people with a combination of metabolic risk factors. We aimed to examine the prevalence of NAFLD, including groups with metabolic risk factors. METHODS AND RESULTS In this cross-sectional analysis of the Netherlands Epidemiology of Obesity (NEO) study, liver fat content was assessed using proton magnetic resonance spectroscopy (H-MRS). Participants with excessive alcohol consumption or missing values were excluded, leaving a total of 1570 participants for the analyses. Mean (SD) age of the population was 55 years, BMI 25.9 (4.0) kg/m2 and 46% were men. The prevalence of NAFLD was 27% (95% CI 24-30). The prevalence of NAFLD was increased in participants with hypertriglyceridemia (57%, 52-63), obesity (62%, 58-66) and diabetes (69%, 61-77). The prevalence of NAFLD was highest in those with diabetes and obesity (79%, 71-87), obesity and hypertriglyceridemia (81%, 76-86) and with diabetes and hypertriglyceridemia (86%, 77-95). NAFLD was also present in 12% (8-16) of participants without overweight. CONCLUSIONS The prevalence of NAFLD in a middle-aged population in the Netherlands in 2010 was 27%. The prevalence of NAFLD is particularly increased in individuals with diabetes, obesity, and hypertriglyceridemia. This information may help clinicians and general practitioners in the risk stratification of their patients in daily practice.
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Affiliation(s)
- Gabrielle Alblas
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands; Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée de Mutsert
- Department of Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Lin F, Wang H, Wang X, Fang Y. Association between exposure to multiple polyaromatic hydrocarbons and periodontitis: findings from a cross-sectional study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:112611-112624. [PMID: 37837582 DOI: 10.1007/s11356-023-29421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/17/2023] [Indexed: 10/16/2023]
Abstract
The impact of environmental pollutant exposure on periodontitis has raised significant concerns. But the association between exposure to multiple polyaromatic hydrocarbons (PAHs) and periodontitis still remained unclear. Our study investigated the association of exposure to multiple PAHs with periodontitis. A total of 1880 participants from the National Health and Nutrition Examination Survey (NHANES) were included in this study. Urinary samples of the participants exposed to six PAHs, namely, 1-hydroxynaphthalene (1-OHN), 2-hydroxynaphthalene (2-OHN), 3-hydroxyfluorene (3-OHF), 2-hydroxyfluorene (2-OHF), 1-hydroxyphenanthrene (1-OHPhe), and 1-hydroxypyrene (1-OHPyr), were investigated. Multiple logistic regression, restricted cubic spline, and Bayesian kernel machine regression (BKMR) models were employed to identify the association between PAH exposures and periodontitis. The dose-response analysis exhibited a gradual increase in the periodontitis risk with an increase in multiple PAHs. After adjustment for several potential confounders, the odds ratio of the highest quartile (Quartile 4) was 1.648 (95% confidence interval (CI) 1.108-2.456, P = 0.014, P-t = 0.017) for 2-OHN, 2.046 (95%CI 1.352-3.104, P < 0.001, P-t = 0.005) for 3-OHF, 1.996 (95% CI 1.310-3.046, P = 0.001, P-t = 0.003) for 2-OHF, 1.789 (95% CI 1.230-2.604, P = 0.002, P-t = 0.003) for 1-OHPhe, and 1.494 (95% CI 1.025-2.181, P = 0.037, P-t = 0.021) for 1-OHPyr compared with that of the lowest quartile (Quartile 1). BKMR illustrated that the overall effect of the PAH mixture was positively related to periodontitis. Mediation analysis identified blood neutrophils as a partial mediator of 3-OHF and 2-OHF. Exposure to multiple PAHs was positively associated with periodontitis in US adults, and blood neutrophils mediate the effects of 3-OHF and 2-OHF therein.
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Affiliation(s)
- Fei Lin
- Department of Stomatology, Fujian Medical University Union Hospital, Fuzhou, 35001, China
| | | | - Xuefei Wang
- Fujian Medical University, Fuzhou, 35001, China
| | - Yihong Fang
- Department of Stomatology, Fujian Medical University Union Hospital, Fuzhou, 35001, China.
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Beroukhim G, Kayani J, Taylor HS, Pal L. Examining the association between urinary triclosan levels and menopausal status: results from the National Health and Nutrition Examination Survey, 2003 to 2016. Menopause 2023; 30:906-912. [PMID: 37625087 DOI: 10.1097/gme.0000000000002233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
OBJECTIVE To examine the association between urinary levels of triclosan (TCS), a ubiquitous endocrine disrupter, and menopausal status using the National Health and Nutrition Examination Survey. METHODS A retrospective cross-sectional study from 2003 to 2016 was conducted among US female participants who completed the reproductive health questionnaire and provided TCS-level measurements. Exposure was assessed by urinary TCS levels adjusted for urinary creatinine; levels were log-transformed to achieve normal distribution for parametric analyses. Menopausal status was based on participants' responses to: "What is the reason that you have not had a period in the past 12 months?" Multivariable linear regression analyses examined the association between creatinine-adjusted urinary TCS levels and menopausal status after adjusting for age at survey completion, body mass index, race, ethnicity, and smoking exposure. RESULTS Of the final sample of female participants (n = 6,958), 40% identified as postmenopausal, of whom 60% had experienced natural menopause, and of these, 11% had become menopausal at under 40 years of age. Triclosan levels correlated positively with advancing age (r = 0.09, P < 0.001) and inversely with body mass index (r = -0.09, P < 0.001). Smoking exposure was associated with significantly lower TCS levels (P < 0.001). Compared with premenopausal women, postmenopausal women had significantly higher log-transformed, creatinine-adjusted TCS levels (mean, -1.22 ± 1.79 vs -1.51 ± 1.79 ng/mg creatinine; P < 0.001). Triclosan levels were unrelated to the duration of menopause and did not differ between women who underwent natural versus surgical menopause, and premature menopause versus menopause at 40 years or older. In unweighted multivariate linear regression analyses, menopausal status was independently associated with higher urinary TCS levels after adjusting for covariates (β coefficient, 0.17; 95% CI, 0.020-0.323; P = 0.026). CONCLUSIONS In a nationally representative sample, postmenopausal status was associated with higher urinary TCS levels, observations that merit further investigation into potential exposures and health consequences.
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Affiliation(s)
- Gabriela Beroukhim
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | | | - Hugh S Taylor
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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Ghahramani S, Hadipour M, Peymani P, Ghahramani S, Lankarani KB. Health-related quality of life variation by socioeconomic status: Evidence from an Iranian population-based study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:287. [PMID: 37849870 PMCID: PMC10578546 DOI: 10.4103/jehp.jehp_1031_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/25/2022] [Indexed: 10/19/2023]
Abstract
BACKGROUND Health-Related Quality of Life (HRQoL) values based on the accurate and reliable European Quality of Life Five Dimension (EQ-5D) questionnaire gives health-state utilities as a helpful data set for studying socio-demographic and socio-economic inequalities in health status in the general population. We aimed to do a population-based study to see how HRQoL varies by socio-demographics and socioeconomic status (SES). MATERIALS AND METHODS The study was a cross-sectional population-based study in Shiraz, Iran's southwest. Data was gathered utilizing a personal digital assistant (PDA). A trained interviewer administered the EQ-5D questionnaire to a representative sample of 1036 inhabitants. Principal component analysis (PCA) was used to create SES indices. Because of the skewed distribution, quantile regression was utilized to model the quartiles of HRQoL values. STATA 12.0 was used to perform all statistical analyses. P <0.05 was considered statistically significant. RESULTS In 1036 study respondents, women had a mean HRQoL of 0.67 ± 0.28, whereas men had a mean HRQoL of 0.78 ± 0.25. Gender and age remained significant in all quartiles of HRQoL value. Participants with insurance showed 0.14 and 0.08 higher HRQoL values in the first and second HRQoL quartiles than those without coverage, respectively. Education [95% CI: 0.034, 0.111)], economy [95% CI: 0.013, 0.077], and assets [95% CI: 0.003, 0.069] all had an impact on HRQoL value in the lowest quintile. CONCLUSION In all quartiles of HRQoL value, women had lower reported HRQoL than men. Insurance programs aimed at more disadvantaged groups with poorer HRQoL may help to minimize inequity. Education, economics, and assets all had an impact on the lower quartiles of HRQoL value, emphasizing the importance of general policies in determining public health status.
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Affiliation(s)
- Sulmaz Ghahramani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Hadipour
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Peymani
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sahar Ghahramani
- Division of Occupational Science and Occupational Therapy at the Ostrow School of Dentistry, University of Southern California, Angeles, CA
| | - Kamran B. Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Abasilim C, Persky V, Turyk ME. Association of Blood Total Mercury with Dyslipidemia in a sample of U.S. Adolescents: Results from the National Health and Nutrition Examination Survey Database, 2011-2018. HYGIENE AND ENVIRONMENTAL HEALTH ADVANCES 2023; 6:100047. [PMID: 38617034 PMCID: PMC11014419 DOI: 10.1016/j.heha.2023.100047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Background Abnormal lipid profiles in adolescents predict metabolic and cardiovascular diseases in adulthood. While seafood consumption is the primary source of mercury exposure, it also provides beneficial nutrients such as omega-3 fatty acids (O3FA). Prior studies indicate that blood total mercury (TBHg) has endocrine disrupting effects and may be associated with abnormal lipid profiles in adolescents. However, the impact of beneficial nutrients on this relationship has not been examined. Our study investigated the relationship of TBHg with dyslipidemia and lipid profiles and potential confounding and modification of these relationships by sex, body mass index (BMI), selenium and O3FA from seafood consumption. Methods We examined 1,390 National Health and Nutrition Examination Survey participants 12-19 years of age from the 2011-2018 cycles. Using logistic and linear regression adjusted for survey design variables and stratified by sex a priori, we estimated the associations of TBHg and methylmercury with dyslipidemia, and with total cholesterol (TC), high (HDL-C) and low-density lipoprotein cholesterol (LDL-C) and triglycerides. Results The geometric mean of TBHg in this adolescent population was 0.44 μg/L. After controlling for socio-demographic covariates, BMI, serum selenium, age at menarche (females only) and average daily intake of O3FA; TBHg was significantly associated with higher TC levels (β=3.34, 95% CI: 0.19, 6.50; p<0.05) in females but not males. Methyl Hg was also associated with increased TC, as well as decreased HDL-C in females but not males. We did not find significant associations of Hg exposure with dyslipidemia, LDL-C or triglycerides levels in either male or female adolescents. However, we observed evidence of effect modification by BMI and serum selenium for associations of TBHg with TC levels in male and female adolescents, respectively. Conclusion Our findings of elevated TC levels in females but not males necessitates further research to better understand the underlying mechanisms driving these sex-specific associations.
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Affiliation(s)
- Chibuzor Abasilim
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL
| | - Mary E. Turyk
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL
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Koemel NA, Senior AM, Benmarhnia T, Holmes A, Okada M, Oulhote Y, Parker HM, Shah S, Simpson SJ, Raubenheimer D, Gill TP, Laouali N, Skilton MR. Diet Quality, Microbial Lignan Metabolites, and Cardiometabolic Health among US Adults. Nutrients 2023; 15:nu15061412. [PMID: 36986142 PMCID: PMC10054147 DOI: 10.3390/nu15061412] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
The gut microbiome has been shown to play a role in the relationship between diet and cardiometabolic health. We sought to examine the degree to which key microbial lignan metabolites are involved in the relationship between diet quality and cardiometabolic health using a multidimensional framework. This analysis was undertaken using cross-sectional data from 4685 US adults (age 43.6 ± 16.5 years; 50.4% female) participating in the National Health and Nutrition Examination Survey for 1999–2010. Dietary data were collected from one to two separate 24-hour dietary recalls and diet quality was characterized using the 2015 Healthy Eating Index. Cardiometabolic health markers included blood lipid profile, glycemic control, adiposity, and blood pressure. Microbial lignan metabolites considered were urinary concentrations of enterolignans, including enterolactone and enterodiol, with higher levels indicating a healthier gut microbial environment. Models were visually examined using a multidimensional approach and statistically analyzed using three-dimensional generalized additive models. There was a significant interactive association between diet quality and microbial lignan metabolites for triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, insulin, oral glucose tolerance, adiposity, systolic blood pressure, and diastolic blood pressure (all p < 0.05). Each of these cardiometabolic health markers displayed an association such that optimal cardiometabolic health was only observed in individuals with both high diet quality and elevated urinary enterolignans. When comparing effect sizes on the multidimensional response surfaces and model selection criteria, the strongest support for a potential moderating relationship of the gut microbiome was observed for fasting triglycerides and oral glucose tolerance. In this study, we revealed interactive associations of diet quality and microbial lignan metabolites with cardiometabolic health markers. These findings suggest that the overall association of diet quality on cardiometabolic health may be affected by the gut microbiome.
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Affiliation(s)
- Nicholas A. Koemel
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- Sydney Medical School, The University of Sydney, Sydney 2006, Australia
| | - Alistair M. Senior
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney 2006, Australia
- Sydney Centre for Precision Data Science, The University of Sydney, Sydney 2006, Australia
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, CA 92093, USA
| | - Andrew Holmes
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney 2006, Australia
| | - Mirei Okada
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney 2006, Australia
| | - Youssef Oulhote
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA
| | - Helen M. Parker
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- Sydney Medical School, The University of Sydney, Sydney 2006, Australia
| | - Sanam Shah
- “Exposome and Heredity” Team, CESP, Paris-Saclay University, UVSQ, University Paris-Sud, Inserm, Gustave Roussy, F-94805 Villejuif, France
| | - Stephen J. Simpson
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney 2006, Australia
| | - David Raubenheimer
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- School of Life and Environmental Sciences, The University of Sydney, Sydney 2006, Australia
| | - Timothy P. Gill
- Charles Perkins Centre, The University of Sydney, Sydney 2006, Australia
- Sydney Medical School, The University of Sydney, Sydney 2006, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney 2006, Australia
| | - Nasser Laouali
- Scripps Institution of Oceanography, University of California, San Diego, CA 92093, USA
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA 01003, USA
- “Exposome and Heredity” Team, CESP, Paris-Saclay University, UVSQ, University Paris-Sud, Inserm, Gustave Roussy, F-94805 Villejuif, France
- Correspondence: (N.L.); (M.R.S.)
| | - Michael R. Skilton
- Sydney Medical School, The University of Sydney, Sydney 2006, Australia
- Correspondence: (N.L.); (M.R.S.)
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van der Velde JHPM, Boone SC, Winters-van Eekelen E, Hesselink MKC, Schrauwen-Hinderling VB, Schrauwen P, Lamb HJ, Rosendaal FR, de Mutsert R. Timing of physical activity in relation to liver fat content and insulin resistance. Diabetologia 2023; 66:461-471. [PMID: 36316401 PMCID: PMC9892088 DOI: 10.1007/s00125-022-05813-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/08/2022] [Indexed: 02/05/2023]
Abstract
AIMS/HYPOTHESIS We hypothesised that the insulin-sensitising effect of physical activity depends on the timing of the activity. Here, we examined cross-sectional associations of breaks in sedentary time and timing of physical activity with liver fat content and insulin resistance in a Dutch cohort. METHODS In 775 participants of the Netherlands Epidemiology of Obesity (NEO) study, we assessed sedentary time, breaks in sedentary time and different intensities of physical activity using activity sensors, and liver fat content by magnetic resonance spectroscopy (n=256). Participants were categorised as being most active in the morning (06:00-12:00 hours), afternoon (12:00-18:00 hours) or evening (18:00-00:00 hours) or as engaging in moderate-to-vigorous-physical activity (MVPA) evenly distributed throughout the day. Most active in a certain time block was defined as spending the majority (%) of total daily MVPA in that block. We examined associations between sedentary time, breaks and timing of MVPA with liver fat content and HOMA-IR using linear regression analyses, adjusted for demographic and lifestyle factors including total body fat. Associations of timing of MVPA were additionally adjusted for total MVPA. RESULTS The participants (42% men) had a mean (SD) age of 56 (4) years and a mean (SD) BMI of 26.2 (4.1) kg/m2. Total sedentary time was not associated with liver fat content or insulin resistance, whereas the amount of breaks in sedentary time was associated with higher liver fat content. Total MVPA (-5%/h [95% CI -10%/h, 0%/h]) and timing of MVPA were associated with reduced insulin resistance but not with liver fat content. Compared with participants who had an even distribution of MVPA throughout the day, insulin resistance was similar (-3% [95% CI -25%, 16%]) in those most active in morning, whereas it was reduced in participants who were most active in the afternoon (-18% [95% CI -33%, -2%]) or evening (-25% [95% CI -49%, -4%]). CONCLUSIONS/INTERPRETATION The number of daily breaks in sedentary time was not associated with lower liver fat content or reduced insulin resistance. Moderate-to-vigorous activity in the afternoon or evening was associated with a reduction of up to 25% in insulin resistance. Further studies should assess whether timing of physical activity is also important for the occurrence of type 2 diabetes.
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Affiliation(s)
| | - Sebastiaan C Boone
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Matthijs K C Hesselink
- Department of Nutrition and Movement Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Vera B Schrauwen-Hinderling
- Department of Nutrition and Movement Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Patrick Schrauwen
- Department of Nutrition and Movement Sciences, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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13
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Fang L, Zhao H, Chen Y, Ma Y, Xu S, Xu S, Pan G, Cai G, Shuai Z, Pan F. The combined effect of heavy metals and polycyclic aromatic hydrocarbons on arthritis, especially osteoarthritis, in the U.S. adult population. CHEMOSPHERE 2023; 316:137870. [PMID: 36642150 DOI: 10.1016/j.chemosphere.2023.137870] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/15/2022] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
The evaluation of heavy metals (HMs) and polycyclic aromatic hydrocarbons (PAHs) impact on arthritis is usually limited to the analysis of the arthritis subtype (rheumatoid arthritis, RA), whereas studies on osteoarthritis (OA) are relatively sparse. Furthermore, the combined effect of HMs and PAHs co-exposure on arthritis also has rarely been analyzed. Herein, we aimed to comprehensively estimate the association between HMs and PAHs (three blood HMs and six urinary PAHs metabolites) co-exposure and arthritis. Using data from the National Health and Nutrition Examination Survey (NHANES), 2003-2016, we included 9735 adults, of whom 2464 had total arthritis, 1371 had OA, and 468 had RA. The logistic regression model was conducted to estimate the single effect of HMs and PAHs on arthritis. Moreover, weighted quantile sum (WQS) regression, quantile-based g computation (qgcomp), and Bayesian kernel machine regression (BKMR) were separately performed to assess the combined effect of HMs and PAHs co-exposure on arthritis. In the single-exposure analyses, cadmium (Cd) and lead (Pb) statistically grew the risk of total arthritis, OA, and RA. Among PAHs, 1-hydroxynaphthalene (1-NAP) and 3-hydroxyfluorene (3-FLU) showed a positive association with total arthritis, OA, and RA. Meanwhile, 2-NAP also was significantly associated with total arthritis. 2-NAP, 2-FLU, and 1-hydroxyphenanthrene (1-PHE) also were significantly associated with RA. Furthermore, the three complementary models consistently demonstrated that co-exposure to high levels of HMs and PAHs was positively associated with total arthritis, OA, and RA risk. The above associations were more obvious in young and medium-aged people. Interestingly, BKMR analyses indicated that 1-NAP might interact with Cd and 3-FLU in total arthritis, while Pb might interact with Cd in OA. Therefore, this study provided novel evidence that co-exposure to HMs and PAHs positively correlated with arthritis, especially OA, and these results were worthy of further prospective studies.
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Affiliation(s)
- Lanlan Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Hui Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Yuting Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Shanshan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Shenqian Xu
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Guixia Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Zongwen Shuai
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China.
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; The Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.
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14
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Laouali N, Benmarhnia T, Lanphear BP, Oulhote Y. Associations with Blood Lead and Urinary Cadmium Concentrations in Relation to Mortality in the US Population: A Causal Survival Analysis with G-Computation. TOXICS 2023; 11:toxics11020133. [PMID: 36851008 PMCID: PMC9966985 DOI: 10.3390/toxics11020133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 05/19/2023]
Abstract
Using the parametric g-formula, we estimated the 27-year risk of all-cause and specific causes of mortality under different potential interventions for blood lead (BLLs) and urinary cadmium (UCd) levels. We used data on 14,311 adults aged ≥20 years enrolled in the NHANES-III between 1988 and 1994 and followed up through 31 Dec 31 2015. Time and cause of death were determined from the National Death Index records. We used the parametric g-formula with pooled logistic regression models to estimate the relative and absolute risk of all-cause, cardiovascular, and cancer mortality under different potential threshold interventions for BLLs and UCd concentrations. Median follow-up was 22.5 years. A total of 5167 (36%) participants died by the end of the study, including 1550 from cardiovascular diseases and 1135 from cancer. Increases in BLLs and creatinine-corrected UCd levels from the 5th to the 95th percentiles were associated with risk differences of 4.17% (1.54 to 8.77) and 6.22% (4.51 to 12.00) for all-cause mortality, 1.52% (0.09 to 3.74) and 1.06% (-0.57 to 3.50) for cardiovascular disease mortality, and 1.32% (-0.09 to 3.67) and 0.64% (-0.98 to 2.80) for cancer mortality, respectively. Interventions to reduce historical exposures to lead and cadmium may have prevented premature deaths, especially from cardiovascular disease.
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Affiliation(s)
- Nasser Laouali
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, Amherst, MA 01003, USA
- Scripps Institution of Oceanography, University of California, San Diego, CA 95616, USA
- CESP UMR1018, Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, 94800 Villejuif, France
- Correspondence:
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, CA 95616, USA
| | - Bruce P. Lanphear
- Child and Family Research Institute, BC Children’s Hospital, Vancouver, BC V6H 3N1, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
| | - Youssef Oulhote
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, Amherst, MA 01003, USA
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15
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O'Halloran A, Whitaker M, Patel K, Allen AE, Copeland KR, Reed C, Reynolds S, Taylor CA, Havers F, Kim L, Wolter K, Garg S. Developing a sampling methodology for timely reporting of population-based COVID-19-associated hospitalization surveillance in the United States, COVID-NET 2020-2021. Influenza Other Respir Viruses 2023; 17:e13089. [PMID: 36625234 PMCID: PMC9835436 DOI: 10.1111/irv.13089] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) required a sampling methodology that allowed for production of timely population-based clinical estimates to inform the ongoing US COVID-19 pandemic response. METHODS We developed a flexible sampling approach that considered reporting delays, differential hospitalized case burden across surveillance sites, and changing geographic and demographic trends over time. We incorporated weighting methods to adjust for the probability of selection and non-response, and to calibrate the sampled case distribution to the population distribution on demographics. We additionally developed procedures for variance estimation. RESULTS Between March 2020 and June 2021, 19,293 (10.4%) of all adult hospitalized cases were sampled for chart abstraction. Variance estimates for select variables of interest were within desired ranges. CONCLUSIONS COVID-NET's sampling methodology allowed for reporting of robust and timely, population-based data on the clinical epidemiology of COVID-19-associated hospitalizations and evolving trends over time, while attempting to reduce data collection burden on surveillance sites. Such methods may provide a general framework for other surveillance systems needing to quickly and efficiently collect and disseminate data for public health action.
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Affiliation(s)
- Alissa O'Halloran
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Michael Whitaker
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Kadam Patel
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA,General Dynamics Information TechnologyAtlantaGeorgiaUSA
| | | | | | - Carrie Reed
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Sue Reynolds
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | | | - Fiona Havers
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Lindsay Kim
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Kirk Wolter
- NORCThe University of ChicagoChicagoIllinoisUSA
| | - Shikha Garg
- COVID‐19 Response TeamCenters for Disease Control and PreventionAtlantaGeorgiaUSA
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16
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Linakis MW, Gustafson P, Allen BC, Bachand AM, Van Landingham C, Keast DR, Longnecker MP. Is the cholesterol-perfluoroalkyl substance association confounded by dietary fiber intake?: a Bayesian analysis of NHANES data with adjustment for measurement error in fiber intake. Environ Health 2022; 21:114. [PMID: 36419083 PMCID: PMC9682702 DOI: 10.1186/s12940-022-00923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Serum concentrations of total cholesterol and related lipid measures have been associated with serum concentrations of per- and polyfluoroalkyl substances (PFAS) in humans, even among those with only background-level exposure to PFAS. Fiber is known to decrease serum cholesterol and a recent report based on National Health and Nutrition Examination Survey (NHANES) showed that PFAS and fiber are inversely associated. We hypothesized that confounding by dietary fiber may account for some of the association between cholesterol and PFAS. METHODS We implemented a Bayesian correction for measurement error in estimated intake of dietary fiber to evaluate whether fiber confounds the cholesterol-PFAS association. The NHANES measure of diet, two 24-h recalls, allowed calculation of an estimate of the "true" long-term fiber intake for each subject. We fit models to the NHANES data on serum cholesterol and serum concentration of perfluorooctanoic acid (PFOA) and two other PFAS for 7,242 participants in NHANES. RESULTS The Bayesian model, after adjustment for soluble fiber intake, suggested a decrease in the size of the coefficient for PFOA by 6.4% compared with the fiber-unadjusted model. CONCLUSIONS The results indicated that the association of serum cholesterol with PFAS was not substantially confounded by fiber intake.
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Affiliation(s)
- Matthew W Linakis
- Ramboll US Consulting, Inc., 3214 Charles B Root Wynd #130, Raleigh, NC 27612, USA
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, Canada
| | - Bruce C Allen
- Independent consultant, Chapel Hill, North Carolina, USA
| | | | | | - Debra R Keast
- Food & Nutrition Database Research, Inc, Bangor, PA, USA
| | - Matthew P Longnecker
- Ramboll US Consulting, Inc., 3214 Charles B Root Wynd #130, Raleigh, NC 27612, USA.
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17
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Green BW, Labagnara K, Macdonald E, Feiertag N, Zhu M, Gupta K, Mohan C, Watts KL, Rai A, Small AC. Evaluating the association between food insecurity and risk of nephrolithiasis: an analysis of the National Health and Nutrition Examination Survey. World J Urol 2022; 40:2641-2647. [PMID: 36125503 DOI: 10.1007/s00345-022-04150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022] Open
Abstract
PURPOSE This study aimed to investigate the relationship between self-reported food security and kidney stone formation. METHODS Data were collected from the National Health and Nutrition Examination Survey (NHANES), a database representative of the United States population. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Characteristics of patients were compared using the Chi-square test and the student t-test. Multivariate logistic regression was performed using a multi-model approach. RESULTS We analyzed 6,800 NHANES survey respondents. 37.2% of respondents were categorized as having "low food security" (scores 2-4) and 24.0% having "very low food security" (scores 5-6). 8.4% of respondents had a history of kidney stones. We found that people with very low food security had a 42% increased likelihood of developing kidney stones compared to those with high or marginal food security, after controlling for race, age, and comorbidities (OR 1.42; 95% CI 1.01-1.99). Between the different food security groups, no significant differences were observed in age, race/ethnicity, body mass index, gout history, osteoporosis history, or coronary artery disease history. Lower food security was associated with slightly younger age (< 1 year difference, p = 0.001), higher poverty-income ratio (p = 0.001), and many comorbidities, including kidney stones (p = 0.007). CONCLUSION Our study provides evidence for an association between food access and the risk of kidney stone disease. Given these findings, food insecurity should be investigated as a modifiable risk factor for the development of kidney stone disease.
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Affiliation(s)
- Benjamin W Green
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Kevin Labagnara
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Eric Macdonald
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Nathan Feiertag
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Michael Zhu
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Kavita Gupta
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Charan Mohan
- Smith Institute for Urology, Northwell Health System, New Hyde Park, NY, USA
| | - Kara L Watts
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA
| | - Arun Rai
- Smith Institute for Urology, Northwell Health System, New Hyde Park, NY, USA
| | - Alexander C Small
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, 1250 Waters Pl, Tower 1 Penthouse, Bronx, NY, 10461, USA.
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18
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Beroukhim G, Kayani J, Taylor HS, Pal L. Implications of triclosan for female fertility: results from the National Health and Nutrition Examination Survey, 2013-2016. F S Rep 2022; 3:204-210. [PMID: 36212563 PMCID: PMC9532887 DOI: 10.1016/j.xfre.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/05/2022] [Accepted: 06/10/2022] [Indexed: 11/01/2022] Open
Abstract
Objective To examine and further characterize the association between urinary levels of triclosan (TCS), a ubiquitous putative endocrine-disrupting chemical, and the risk of infertility. Design A retrospective cross-sectional study using the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey. Setting Not applicable. Patients Female participants in the United States who completed the reproductive health questionnaire and provided urine samples for TCS level measurement from 2013 to 2016. Interventions None. Main Outcome Measures Rates of presumed infertility based on participants' affirmative response to survey question RHQ074 ("Have you ever attempted to become pregnant over a period of at least a year without becoming pregnant?"). Results A total of 11.7% of the overall female and 12.5% of the eligible study population met the criterion for presumed infertility. Creatinine-adjusted urinary TCS levels were significantly higher among those meeting the criterion for infertility compared with the levels among those who did not. On multivariable-adjusted analyses, individuals with undetectable levels of urinary TCS were 35% less likely to meet the specified infertility criterion compared with those with detectable TCS levels. The magnitude of association between TCS levels and infertility was strongest when comparing the lowest and highest quartiles. The directionality and magnitude of the relationship between TCS levels and infertility were maintained on age-restricted and weighted analyses; however, the associations did not retain statistical significance. Conclusions In a nationally representative sample of women in the United States, an association between TCS exposure and inability to conceive over a period of 1 year is suggested by our analysis of the National Health and Nutrition Examination Survey data. The data infer a dose-response relationship.
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Affiliation(s)
- Gabriela Beroukhim
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
- Reprint requests: Gabriela Beroukhim, M.D., Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine, 333 Cedar Street, FMB 329H, Yale School of Medicine, New Haven, Connecticut 06510.
| | | | - Hugh S. Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Lubna Pal
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
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Snow M, Vranich TM, Perin J, Trent M. Estimates of infertility in the United States: 1995-2019. Fertil Steril 2022; 118:560-567. [PMID: 35710598 DOI: 10.1016/j.fertnstert.2022.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To estimate the changes in infertility from 1995-2019 and determine the association of individual-level characteristics with fertility in the United States. DESIGN Cross-sectional study. SETTING Periodic data from 1995, 2002, 2006-2010, 2011-2013, 2013-2015, 2015-2017, and 2017-2019 cycles of the National Survey for Family Growth were used for this analysis. The National Survey for Family Growth comprises samples of the household-level population of women aged 15-44 years in the United States. PATIENT(S) Surveyed married and cohabiting women aged 15-44 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The primary outcomes were the rates of infertility across subgroups of married or cohabiting women. For secondary outcomes, we performed bivariable and multivariable logistic regression models using the pooled sample (N = 53,764) to determine the association of individual-level characteristics, including age, parity, pelvic inflammatory disease treatment, education, income, race or ethnicity, and receipt of sexual and reproductive health services, with the odds of 12-month infertility among married or cohabiting women. RESULT(S) The fluctuations in infertility over this period, with a low of 5.8% in 2006-2010 and a high of 8.1% in 2017-2019, were not found to be statistically significant. This trend was present across nearly all subgroups. The multivariable model showed that women who were older and nulliparous, had fewer years of education, had lower income, were non-Hispanic black, or were not receiving sexual and reproductive health services were more likely to be infertile. CONCLUSION(S) This study confirms that parity, age, race, and education level continue to have an association with infertility. Further, the results demonstrate that access to sexual and reproductive health services plays an important role in infertility. In contrast to previous studies, infertility in the United States is no longer on the decline, and Hispanic ethnicity did not have a significant relationship with infertility. Given the rise of sexually transmitted infections and the persistent lack of access to sexual and reproductive health services, particularly among already vulnerable groups, the connection between access to care and infertility is ripe for further investigation.
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Affiliation(s)
- Morgan Snow
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Tyler M Vranich
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jamie Perin
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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20
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Exploring the association of organochlorine pesticides exposure and hearing impairment in United States adults. Sci Rep 2022; 12:11887. [PMID: 35831449 PMCID: PMC9279322 DOI: 10.1038/s41598-022-15892-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/30/2022] [Indexed: 12/02/2022] Open
Abstract
Hearing loss (HL) is a highly prevalent public health concern. Organochlorine pesticides (OCPs) are widely used environmental pollutants harmful to human health. Studies investigating the effects of OCPs exposure on the auditory system in the general population are rare. To explore the association between OCPs exposure and HL in adults, 366 adults aged 20–69 years who participated in the National Health and Nutrition Examination Survey (NHANES, 2003–2004) were investigated. HL was defined as a pure-tone average (PTA) ≥ 20 dB in the better ear. Multivariate linear and logistic regression analyses were conducted to evaluate the association of four selected serum OCPs with PTAs and the risk of HL. In participants aged < 60 years, hexachlorobenzene (HCB) and dichlorodiphenyldichloroethylene (p, p'-DDE) exposure was positively associated with low- and speech-frequency PTAs, and with low-frequency HL, respectively. Risk of HL increased in the highest tertile compared with the lowest tertile of serum HCB and p, p'-DDE (odds ratio [OR]: 4.38, 95% confidence interval [CI]: 0.97–19.80; OR: 16.66, 95% CI: 2.64–105.09, respectively). In this study of US adults aged < 60 years, HCB and p, p'-DDE exposure was positively associated with HL. HCB and p, p'-DDE may be potential risk factors for HL.
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Klarenberg H, Dekkers IA, Peeters CFW, de Mutsert R, Jukema JW, Rosendaal FR, Leiner T, Gosselink M, Froeling M, Strijkers GJ, Boekholdt SM, Lamb HJ. Confirmatory factor analysis including MRI-derived adipose tissues quantification improves associations of metabolic dysregulation to diastolic dysfunction. J Diabetes Complications 2022; 36:108202. [PMID: 35491309 DOI: 10.1016/j.jdiacomp.2022.108202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/29/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Abstract
AIMS To quantify metabolic impairment via a one-factor approach with confirmatory factor analysis (CFA) including MRI-derived visceral and subcutaneous adipose tissues and to associate it with diastolic dysfunction. METHODS In this cross-sectional analysis, 916 participants (53% female, mean age (SD): 56 (6)) underwent abdominal and cardiovascular MRI. With CFA a metabolic-load factor of metabolic-syndrome variables and visceral and subcutaneous adipose tissues was constructed. A piecewise structural equation model approach with adjustment for confounding factors was used to determine associations with left-ventricular diastolic function, cardiac morphology and hemodynamics. RESULTS Model fitting excluding blood pressure and waist circumference but including visceral and subcutaneous adipose tissues, fasting glucose, HDL-c and triglycerides was used to construct the metabolic-load factor. Evaluating measurement invariance demonstrated sex-specificity. Change in mitral early/late peak filling rate ratio was -0.12 for both males [-0.20; -0.05, p > 0.05] and females [-0.17; -0.07, p > 0.001] per SD of metabolic-load factor. Change in deceleration time of mitral early filling was -11.83 ms in females [-17.38; -6.27] per SD of metabolic-load factor. CONCLUSION A single latent metabolic-load factor via CFA including MRI-derived adipose tissues increased sensitivity for metabolic impairment obsoleting waist circumference and is associated with a decreased left-ventricular diastolic function, more apparent in females than in males.
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Affiliation(s)
- Hugo Klarenberg
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, the Netherlands.
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Carel F W Peeters
- Department of Epidemiology & Datascience, Amsterdam Public Health Research Institute, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands; Division of Mathematical & Statistical Methods - Biometris, Wageningen University & Research, Wageningen, the Netherlands
| | - R de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mark Gosselink
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, the Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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22
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Exploring the relationship between socioeconomic status and erectile dysfunction: an analysis of the National Health and Nutrition Examination Survey. Int J Impot Res 2022:10.1038/s41443-022-00584-2. [PMID: 35590043 DOI: 10.1038/s41443-022-00584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/08/2022]
Abstract
The aim of this study was to investigate the association between socioeconomic status and erectile dysfunction. Data were obtained from the National Health and Nutrition Examination Survey, a nationally representative survey of the United States population. Socioeconomic status was estimated using the poverty income ratio, a ratio of family income to established poverty levels. Erectile function was assessed from a single survey question and was divided into two groups: normal (always and usually able to maintain an erection) and erectile dysfunction (sometimes or never able to maintain an erection). Multivariable logistic regression, using a multi-model approach, was used to characterize the interplay between well-established risk factors for erectile dysfunction and socioeconomic status. Our final cohort included 3679 respondents, representative of 81,255,155 subjects with a mean age of 44.4 [SE, 0.365]. Multivariable logistic regression showed that low-income respondents were significantly more likely to report erectile dysfunction [adjusted odds ratio (AOR) = 1.95, 95% CI 1.28-2.96; p = 0.003] compared to higher-income respondents. This study suggests that low socioeconomic status may be associated with erectile dysfunction in a large, nationally representative sample.
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23
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Freisthler MS, Robbins CR, Benbrook CM, Young HA, Haas DM, Winchester PD, Perry MJ. Association between increasing agricultural use of 2,4-D and population biomarkers of exposure: findings from the National Health and Nutrition Examination Survey, 2001-2014. Environ Health 2022; 21:23. [PMID: 35139875 PMCID: PMC8830015 DOI: 10.1186/s12940-021-00815-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/08/2021] [Indexed: 05/15/2023]
Abstract
BACKGROUND 2,4-Dichlorophenoxyacetic acid (2,4-D) is one of the most extensively used herbicides in the United States. In 2012, 2,4-D was the most widely used herbicide in non-agricultural settings and the fifth most heavily applied pesticide in the US agricultural sector. The objective of this study was to examine trends in 2,4-D urinary biomarker concentrations to determine whether increases in 2,4-D application in agriculture are associated with increases in biomonitoring levels of urine 2,4-D. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) with available urine 2,4-D biomarker measurements from survey cycles between 2001 and 2014 were utilized. Urine 2,4-D values were dichotomized using the highest limit of detection (LOD) across all cycles (0.40 μg/L or 0.4 ppb). Agricultural use of 2,4-D was estimated by compiling publicly available federal and private pesticide application data. Logistic regression models adjusted for confounders were fitted to evaluate the association between agricultural use of 2,4-D and urine 2,4-D level above the dichotomization threshold. RESULTS Of the 14,395 participants included in the study, 4681 (32.5%) had urine 2,4-D levels above the dichotomization threshold. The frequency of participants with high 2,4-D levels increased significantly (p < .0001), from a low of 17.1% in 2001-2002 to a high of 39.6% in 2011-2012. The adjusted odds of high urinary 2,4-D concentrations associated with 2,4-D agricultural use (per ten million pounds applied) was 2.268 (95% CI: 1.709, 3.009). Children ages 6-11 years (n = 2288) had 2.1 times higher odds of having high 2,4-D urinary concentrations compared to participants aged 20-59 years. Women of childbearing age (age 20-44 years) (n = 2172) had 1.85 times higher odds than men of the same age. CONCLUSIONS Agricultural use of 2,4-D has increased substantially from a low point in 2002 and it is predicted to increase further in the coming decade. Because increasing use is likely to increase population level exposures, the associations seen here between 2,4-D crop application and biomonitoring levels require focused biomonitoring and epidemiological evaluation to determine the extent to which rising use and exposures cause adverse health outcomes among vulnerable populations (particularly children and women of childbearing age) and highly exposed individuals (farmers, other herbicide applicators, and their families).
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Affiliation(s)
- Marlaina S Freisthler
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - C Rebecca Robbins
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | | | - Heather A Young
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA
| | - David M Haas
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Paul D Winchester
- Neonatology, Indiana University School of Medicine/Riley Hospital, Indianapolis, Indiana, USA
| | - Melissa J Perry
- Department of Environmental and Occupational Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Suite 400, Washington, DC, 20052, USA.
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Circadian timing of eating and BMI among adults in the American Time Use Survey. Int J Obes (Lond) 2022; 46:287-296. [PMID: 34671108 PMCID: PMC8799482 DOI: 10.1038/s41366-021-00983-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 09/30/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND/OBJECTIVES Experimental studies of time-restricted eating suggest that limiting the daily eating window, shifting intake to the biological morning, and avoiding eating close to the biological night may promote metabolic health and prevent weight gain. SUBJECTS/METHODS We used the Eating & Health Module of the 2006-2008 and 2014-2016 American Time Use Survey to examine cross-sectional associations of timing of eating in relation to sleep/wake times as a proxy for circadian timing with body mass index (BMI). The analytical sample included 38 302 respondents (18-64 years; BMI 18.5-50.0 kg/m2). A single 24-hour time use diary was used to calculate circadian timing of eating variables: eating window (time between first and last eating activity); morning fast (time between end of sleep and start of eating window); and evening fast (time between end of eating window and start of sleep). Multinomial logistic regression and predictive margins were used to estimate adjusted population prevalences (AP) by BMI categories and changes in prevalences associated with a one-hour change in circadian timing of eating, controlling for sociodemographic and temporal characteristics. RESULTS A one-hour increase in eating window was associated with lower adjusted prevalence of obesity (AP = 27.1%, SE = 0.1%). Conversely, a one-hour increase in morning fast (AP = 28.7%, SE = 0.1%) and evening fast (AP = 28.5%, SE = 0.1%) were each associated with higher prevalence of obesity; interactions revealed differing patterns of association by combination of eating window with morning/evening fast (p < 0.0001). CONCLUSIONS Contrary to hypotheses, longer eating windows were associated with a lower adjusted prevalence of obesity and longer evening fasts were associated with a higher prevalence of obesity. However, as expected, longer morning fast was associated with a higher adjusted prevalence of obesity. Studies are needed to disentangle the contributions of diet quality/quantity and social desirability bias in the relationship between circadian timing of eating and BMI.
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Association between blood metals mixtures concentrations and cognitive performance, and effect modification by diet in older US adults. Environ Epidemiol 2022; 6:e192. [PMID: 35169670 PMCID: PMC8835643 DOI: 10.1097/ee9.0000000000000192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/14/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Chronic exposure to heavy metals has been associated with adverse neurological outcomes in older adults. Inflammatory processes are suspected as an underlying pathway by which metals exert their neurotoxicity. In parallel, a diet rich in antioxidant and anti-inflammatory components may protect against chronic inflammation. Objectives: We examined the associations of blood concentrations of lead, cadmium, and manganese as a mixture with cognitive performance in older US adults and potential modification of these associations by diet as measured by the Healthy Eating Index 2015 (HEI-2015) and the Adapted Dietary Inflammatory Index (ADII). Methods: We used data on 1,777 adults ≥60 years old from the US National Health and Nutrition Examination Survey (NHANES; 2011–2014). We derived the ADII and the HEI-2015 from two nonconsecutive 24-hour diet recalls. Cognitive performance was measured by the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Word Learning subtest, the animal fluency test, and the Digit Symbol Substitution Test (DSST). We also constructed a composite z-score reflecting overall cognitive performance. We used quantile g-computation to evaluate the joint associations of a mixture of metals with cognitive performance test scores. We also evaluated effect modification by sex and diet quality indices using Cochran Q tests. Results: The median (interquartile range) of blood metals were 0.38 μg/L (0.35), 14.70 μg/L (11.70), and 8.74 μg/L (4.06) for cadmium, lead, and manganese, respectively. Increasing blood concentrations of all metals by one quartile was associated with a decrease in overall cognitive performance (–0.04; 95% confidence interval [CI] = –0.09, 0.02), CERAD (–0.04; 95% CI = –0.12, 0.03), animal fluency (–0.02; 95% CI, –0.11, 0.06), and DSST (–0.05; 95% CI = –0.11, 0.02) test scores. These associations were more pronounced in adults with high pro-inflammatory or low-diet quality and null or positive though imprecise associations in participants with a high anti-inflammatory. These associations also varied by sex with inverse associations in men and positive associations in women. Conclusions: Our findings suggest that adherence to an antioxidant and anti-inflammatory diet may prevent blood metals adverse cognitive effects among older adults. If confirmed, strategies based on diet could provide a potential complementary and efficient approach to counteract effects of environmental pollutants.
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Christen T, de Mutsert R, Lamb HJ, van Dijk KW, le Cessie S, Rosendaal FR, Jukema JW, Trompet S. Mendelian randomization study of the relation between adiponectin and heart function, unravelling the paradox. Peptides 2021; 146:170664. [PMID: 34597752 DOI: 10.1016/j.peptides.2021.170664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 12/23/2022]
Abstract
High adiponectin concentrations are generally regarded as beneficial with regard to cardiometabolic health, but have been paradoxically associated with increased cardiovascular disease risk, specifically heart failure, in individuals at high cardiovascular risk. We aimed to investigate the association between adiponectin and heart function parameters, and inversely, we estimated the effect of genetically-determined heart function and NT-proBNP as the main marker of heart failure on adiponectin using Mendelian randomisation. Observational analyses between adiponectin and measures of heart function, i.e. E/A ratio, left, and right ventricular ejection fraction, were performed in participants of the Netherlands Epidemiology of Obesity (NEO) study, assessed by MRI of the heart (n = 1,138). Two-sample Mendelian randomisation analyses were conducted to estimate the effect of NT-proBNP and heart function on adiponectin concentrations using publicly-available summary statistics (ADIPOGen; the PLATO trial). The mean (standard deviation) age was 56 (6) years and mean body mass index was 26 (4) kg/m2. Per five μg/mL higher adiponectin, the E/A ratio was -0.05 (95 % CI: -0.10, -0.01) lower, left ventricle ejection fraction was -0.5 % (95 % CI: -1.1, 0.1) lower, and right ventricle ejection fraction was 0.5 % (95 % CI: -0.1, 1.2) higher. Genetically-determined NT-proBNP was causally related to adiponectin concentrations in ADIPOGen: per doubling of genetically-determined NT-proBNP, adiponectin concentrations were 11.4 % (95 % CI: 1.7, 21.6) higher. With causal MR methods we showed that NT-proBNP affects adiponectin concentrations, while adiponectin is not associated with heart function parameters. Therefore, reverse causation may explain the adiponectin paradox observed in previous studies.
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Affiliation(s)
- Tim Christen
- Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands.
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands.
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Netherlands.
| | - Ko Willems van Dijk
- Department of Human Genetics and Department of Medicine, Division Endocrinology, Leiden University Medical Center, Netherlands.
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands.
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Netherlands.
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Netherlands.
| | - Stella Trompet
- Department of Cardiology, Department of Gerontology and Geriatrics, Leiden University Medical Center, Netherlands.
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Zimmerman LA, Sarnak DO, Karp C, Wood SN, Ahmed S, Makumbi F, Kibira SPS. Association between experience of specific side-effects and contraceptive switching and discontinuation in Uganda: results from a longitudinal study. Reprod Health 2021; 18:239. [PMID: 34838097 PMCID: PMC8627069 DOI: 10.1186/s12978-021-01287-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/06/2021] [Indexed: 03/29/2023] Open
Abstract
Background There is substantial evidence that contraceptive side-effects are a major deterrent to consistent use of contraception but few studies in low- or middle-income countries explore the role of specific side-effects on contraceptive use dynamics. This study used population-based, longitudinal data to explore the effect of specific side-effects on contraceptive continuation, discontinuation, and switching in Uganda. Methods Data for this study come from two rounds of survey data collection in Uganda: PMA2020’s sixth cross-sectional survey and a follow-up survey conducted 1 year later. The main outcomes of interest were discontinuation and switching among users of hormonal contraceptive methods (implants, injectables and oral pill) and the IUD at baseline (n = 560). Multivariable logistic regressions assessed the association of experiencing specific side-effects (more bleeding, less bleeding, irregular bleeding, increased dryness/reduced libido, and physical discomfort) with discontinuation and switching 1 year later, adjusting for socio-demographic characteristics, type of method, and length of use. We also examined the differential effects of side-effects between discontinuation and switching risks. Results About 23% of hormonal and IUD contraceptive users reported experiencing side-effects at baseline survey. Overall, discontinuation and switching were higher among injectables and pill users, compared to IUD and implants users. Reporting more bleeding or less bleeding increased the odds of discontinuation and switching by 2.74 (95% CI 1.00–7.51) and 1.86 (1.04–3.34), respectively. There was no significant difference in discontinuation and switching by side-effects. Conclusions Greater attention should be paid to understanding the unique contributions of side-effects to contraceptive behavior using population-based data. While about a quarter of women reported experiencing side effects, those who experienced bleeding specific side effects were at higher risk of contraceptive discontinuation and switching. Providing greater individualized care that includes information and counseling about common side-effects, how they may impact daily life, and how tolerable these effects may be is necessary. Research has shown that experiencing side-effects is related to stopping use of contraception, even when women wish to avoid pregnancy. Most research, however, does not differentiate between distinct side-effects, such as increased bleeding or changes to sexual experience, and instead combined all into “side-effects or health concerns”. We used data from 560 women in Uganda, who were interviewed twice, 1 year apart, to see if women who reported different side-effects at the first interview were more likely to stop using contraception or switch to a different contraceptive method than women who did not report experiencing side-effects. We found that increased or decreased menstrual bleeding was associated with a higher odds of contraceptive discontinuation and switching, Contraceptive discontinuation or switching was not different by women’s reporting of vaginal dryness/reduced libido or physical discomfort, such as cramping. It is important to understand what side-effects are likely to motivate stopping or switching contraception so that education and counseling can inform women of side-effects they may experience, help them choose the best method based on what side-effects they deem important, and if necessary, aid in switching contraceptive methods.
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Affiliation(s)
- Linnea A Zimmerman
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Dana O Sarnak
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Celia Karp
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Saifuddin Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
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Schroijen MA, de Mutsert R, Dekker FW, de Vries APJ, de Koning EJP, Rabelink TJ, Rosendaal FR, Dekkers OM. The association of glucose metabolism and kidney function in middle-aged adults. Clin Kidney J 2021; 14:2383-2390. [PMID: 34754434 PMCID: PMC8572983 DOI: 10.1093/ckj/sfab074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous clinical studies have shown that various measures of glucose metabolism are associated with a risk of chronic kidney disease in different populations, but results were not consistent. In this study we assessed measures of glucose metabolism and their association with kidney function in a population-based study. METHODS The Netherlands Epidemiology of Obesity study is a population-based cohort study of middle-aged men and women. We categorized the study population according to glycaemic levels into normoglycaemia (reference group), pre-diabetes mellitus (pre-DM), known DM and newly diagnosed DM. Outcome variables were serum creatinine, estimated glomerular filtration rate (eGFR), glomerular hyperfiltration (defined as an eGFR >90th percentile; >102 mL/min/1.73 m2) and micro-albuminuria. We examined the association between measures of glucose metabolism [fasting glucose, haemoglobin A1c (HbA1c), fasting insulin, glucose area under the curve (AUC), insulin AUC, Homoeostatic Model Assessment of Insulin Resistance (HOMA-IR), HOMA of β-cell function (HOMA-B) and disposition index] and measures of kidney function. RESULTS Of the total population (N = 6338), 55% of participants were classified as normoglycaemic (reference), 35% as pre-DM, 7% as DM and 4% as newly diagnosed DM. Compared with the reference group, diagnosed and newly diagnosed DMs were associated with a slightly higher trend in eGFR {+2.1 mL/min/1.73 m2 [95% confidence interval (CI) -0.2-4.4] and +2.7 mL/min/1.73 m2 [95% CI -0.3-5.7], respectively}. A 1% higher HbA1c was associated with increased odds of hyperfiltration [odds ratio (OR) 1.41 (95% CI 1.06-1.88)]. Higher levels of fasting plasma glucose, AUC glucose and HOMA-B were associated with hyperfiltration. Fasting insulin, AUC insulin and HOMA-IR were not associated with hyperfiltration. The OR of microalbuminuria was 1.21 (95% CI 1.04-1.42) per mmol/L higher fasting glucose concentrations. CONCLUSIONS Both fasting and post-prandial glucose and HOMA-B, but not measures of insulin resistance, were associated with glomerular hyperfiltration, while fasting glucose was also associated with microalbuminuria.
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Affiliation(s)
- Marielle A Schroijen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aiko P J de Vries
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Eelco J P de Koning
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ton J Rabelink
- Department of Internal Medicine, Division of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Olaf M Dekkers
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
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Winters-VAN Eekelen E, VAN DER Velde JHPM, Boone SC, Westgate K, Brage S, Lamb HJ, Rosendaal FR, DE Mutsert R. Objectively Measured Physical Activity and Body Fatness: Associations with Total Body Fat, Visceral Fat, and Liver Fat. Med Sci Sports Exerc 2021; 53:2309-2317. [PMID: 34081059 PMCID: PMC7611840 DOI: 10.1249/mss.0000000000002712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE It remains unclear to what extent habitual physical activity and sedentary time (ST) are associated with visceral fat and liver fat. We studied the substitution of ST with time spent physically active and total body fat (TBF), visceral adipose tissue (VAT), and hepatic triglyceride content (HTGC) in middle-age men and women. DESIGN In this cross-sectional analysis of the Netherlands Epidemiology of Obesity study, physical activity was assessed in 228 participants using a combined accelerometer and heart rate monitor. TBF was assessed by the Tanita bioelectrical impedance, VAT by magnetic resonance imaging, and HTGC by proton-MR spectroscopy. Behavioral intensity distribution was categorized as ST, time spent in light physical activity (LPA), and moderate to vigorous physical activity (MVPA). To estimate the effect of replacing 30 min·d-1 of ST with 30 min·d-1 LPA or MVPA, we performed isotemporal substitution analyses, adjusted for sex, age, ethnicity, education, the Dutch Healthy Diet index, and smoking. RESULTS Included participants (41% men) had a mean ± SD age of 56 ± 6 yr and spent 88 ± 56 min in MVPA and 9.0 ± 2.1 h of ST. Replacing 30 min·d-1 of ST with 30 min of MVPA was associated with 1.3% less TBF (95% confidence interval = -2.0 to -0.7), 7.8 cm2 less VAT (-11.6 to -4.0), and 0.89 times HTGC (0.82-0.97). Replacement with LPA was not associated with TBF (-0.03%; -0.5 to 0.4), VAT (-1.7 cm2; -4.4 to 0.9), or HTGC (0.98 times; 0.92-1.04). CONCLUSIONS Reallocation of time spent sedentary with time spent in MVPA, but not LPA, was associated with less TBF, visceral fat, and liver fat. These findings contribute to the development of more specified guidelines on ST and physical activity.
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Affiliation(s)
| | | | - Sebastiaan C Boone
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, THE NETHERLANDS
| | - Kate Westgate
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UNITED KINGDOM
| | - Søren Brage
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge, UNITED KINGDOM
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, THE NETHERLANDS
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, THE NETHERLANDS
| | - Renée DE Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, THE NETHERLANDS
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Verkouter I, Noordam R, Loh NY, van Dijk KW, Zock PL, Mook-Kanamori DO, le Cessie S, Rosendaal FR, Karpe F, Christodoulides C, de Mutsert R. The Relation Between Adult Weight Gain, Adipocyte Volume, and the Metabolic Profile at Middle Age. J Clin Endocrinol Metab 2021; 106:e4438-e4447. [PMID: 34181708 PMCID: PMC8530710 DOI: 10.1210/clinem/dgab477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Indexed: 12/02/2022]
Abstract
CONTEXT Weight gain during adulthood increases cardiometabolic disease risk, possibly through adipocyte hypertrophy. OBJECTIVE We aimed to study the specific metabolomic profile of adult weight gain, and to examine its association with adipocyte volume. METHODS Nuclear magnetic resonance-based metabolomics were measured in the Netherlands Epidemiology of Obesity (NEO) study (n = 6347, discovery) and Oxford Biobank (n = 6317, replication). Adult weight gain was calculated as the absolute difference between body mass index (BMI) at middle age and recalled BMI at age 20 years. We performed linear regression analyses with both exposures BMI at age 20 years and weight gain, and separately with BMI at middle age in relation to 149 serum metabolomic measures, adjusted for age, sex, and multiple testing. Additionally, subcutaneous abdominal adipocyte biopsies were collected in a subset of the Oxford Biobank (n = 114) to estimate adipocyte volume. RESULTS Mean (SD) weight gain was 4.5 (3.7) kg/m2 in the NEO study and 3.6 (3.7) kg/m2 in the Oxford Biobank. Weight gain, and not BMI at age 20 nor middle age, was associated with concentrations of 7 metabolomic measures after successful replication, which included polyunsaturated fatty acids, small to medium low-density lipoproteins, and total intermediate-density lipoprotein. One SD weight gain was associated with 386 μm3 (95% CI, 143-629) higher median adipocyte volume. Adipocyte volume was associated with lipoprotein particles specific for adult weight gain. CONCLUSION Adult weight gain is associated with specific metabolomic alterations of which the higher lipoprotein concentrations were likely contributed by larger adipocyte volumes, presumably linking weight gain to cardiometabolic disease.
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Affiliation(s)
- Inge Verkouter
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC Leiden, the Netherlands
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, 2300 RC Leiden, the Netherlands
| | - Nellie Y Loh
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, OX3 7LE, UK
| | - Ko Willems van Dijk
- Department of Human Genetics, Leiden University Medical Center, 2300RC Leiden, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, 2300RC Leiden, the Netherlands
| | - Peter L Zock
- Department of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC Leiden, the Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC Leiden, the Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, 2300RC Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC Leiden, the Netherlands
| | - Fredrik Karpe
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, OX3 7LE, UK
- National Institute for Health Research, Oxford Biomedical Research Centre, Oxford, OX4 2PG, UK
- Oxford University Hospitals Foundation Trust, Oxford, OX4 4XN, UK
| | - Costantinos Christodoulides
- Radcliffe Department of Medicine, Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, OX3 7LE, UK
- Oxford University Hospitals Foundation Trust, Oxford, OX4 4XN, UK
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, 2300RC Leiden, the Netherlands
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Al Hussein Al Awamlh S, Berkowitz S, Breazzano MP, Finn AP, Patel S. Disparities in Self-Reported Difficulty Seeing in the United States. Ophthalmology 2021; 129:456-458. [PMID: 34678317 DOI: 10.1016/j.ophtha.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/30/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Sean Berkowitz
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee
| | - Mark P Breazzano
- Wilmer Eye Institute, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Avni P Finn
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee
| | - Shriji Patel
- Vanderbilt University Medical Center, Department of Ophthalmology, Nashville, Tennessee.
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32
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Feng S, Sullivan SG, Tchetgen Tchetgen EJ, Cowling BJ. The Causal Interpretation of "Overall Vaccine Effectiveness" in Test-Negative Studies. Am J Epidemiol 2021; 190:1993-1999. [PMID: 33831173 DOI: 10.1093/aje/kwab101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/22/2021] [Accepted: 04/05/2021] [Indexed: 11/14/2022] Open
Abstract
Test-negative studies are commonly used to estimate influenza vaccine effectiveness (VE). In a typical study, an "overall VE" estimate based on data from the entire sample may be reported. However, there may be heterogeneity in VE, particularly by age. Therefore, in this article we discuss the potential for a weighted average of age-specific VE estimates to provide a more meaningful measure of overall VE. We illustrate this perspective first using simulations to evaluate how overall VE would be biased when certain age groups are overrepresented. We found that unweighted overall VE estimates tended to be higher than weighted VE estimates when children were overrepresented and lower when elderly persons were overrepresented. Then we extracted published estimates from the US Flu VE network, in which children are overrepresented, and some discrepancy between unweighted and weighted overall VE was observed. Differences in weighted versus unweighted overall VE estimates could translate to substantial differences in the interpretation of individual risk reduction among vaccinated persons and in the total averted disease burden at the population level. Weighting of overall estimates should be considered in VE studies in the future.
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Willems RPJ, van Dijk K, Dierikx CM, Twisk JWR, van der Klis FRM, de Greeff SC, Vandenbroucke-Grauls CMJE. Gastric acid suppression, lifestyle factors and intestinal carriage of ESBL and carbapenemase-producing Enterobacterales: a nationwide population-based study. J Antimicrob Chemother 2021; 77:237-245. [PMID: 34550358 PMCID: PMC8730682 DOI: 10.1093/jac/dkab345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 08/15/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Gastric acid-suppressive therapy has been suggested to increase the risk for intestinal carriage of MDR Enterobacterales, but there is scarce community-based evidence substantiating this risk. OBJECTIVES To investigate if acid-suppressant use is associated with a risk of intestinal carriage of ESBL and carbapenemase-producing Enterobacterales (ESBL-E) in the open population, and to assess possible modifying factors. METHODS Within the framework of a nationwide seroprevalence study, we identified a population-based cross-sectional cohort comprising 2746 adults (≥18 years), who provided stool specimens between February 2016 and June 2017. Specimens were tested by phenotypic assays and confirmatory genotype analysis to detect carriage of ESBL-E. Covariate data were extracted from self-administered questionnaires. ORs and 95% CIs were estimated using multivariable multilevel logistic regression, controlling for confounders informed by directed acyclic graphs. RESULTS Among 2746 participants, 316 (11.5%) used acid suppressants; the prevalence of ESBL-E carriage was 7.4% (95% CI, 6.1%-8.6%). Current use of acid suppressants was not associated with ESBL-E carriage (adjusted OR [aOR], 1.05; 95% CI, 0.64-1.74); lifestyle and comorbidity did not modify this association. A higher BMI (≥25 kg/m2) (aOR, 1.42 [95% CI, 1.02-1.98]), non-Western ethnic origin (aOR, 1.96 [95% CI, 1.34-2.87]), travel to Eastern-Mediterranean, Western-Pacific or South-East Asia regions (aOR, 3.16 [95% CI, 1.71-5.83]) were associated with ESBL-E carriage. Sensitivity analyses confirmed these results; spline analysis supported a BMI-associated risk. CONCLUSIONS In this open population study, current use of acid suppressants was not associated with ESBL-E carriage. Travel to high-endemic regions and non-Western ethnicity were confirmed as risk factors, while a higher BMI emerged as a potential new risk for ESBL-E carriage.
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Affiliation(s)
- Roel P J Willems
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Karin van Dijk
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Cindy M Dierikx
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Jos W R Twisk
- Department of Clinical Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Fiona R M van der Klis
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Centre for Immunology of Infectious Diseases and Vaccines-Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Sabine C de Greeff
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Centre for Epidemiology and Surveillance of Infectious Diseases-Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Christina M J E Vandenbroucke-Grauls
- Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity Institute, Amsterdam UMC, Amsterdam Medical Center, Amsterdam, The Netherlands
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R van Buul A, J Kasteleyn M, Poberezhets V, N Bonten T, De Mutsert R, S Hiemstra P, le Cessie S, R Rosendaal F, H Chavannes N, Taube C. Factors associated with physical activity among COPD patients with mild or moderate airflow obstruction. Monaldi Arch Chest Dis 2021; 92. [PMID: 34523325 DOI: 10.4081/monaldi.2021.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Physical inactivity is already present among patients with chronic obstructive pulmonary disease (COPD) of mild or moderate airflow obstruction. Most previous studies that reported on determinants of physical activity in COPD included patients with severe COPD. Therefore, the aim of this study was to explore which patient characteristics were related with physical activity in COPD patients with mild or moderate airflow obstruction. Cross-sectional analyses were performed on patients selected from the population-based Netherlands Epidemiology of Obesity study. Patients were included if they had a physician-diagnosed COPD GOLD 0-2 or had newly diagnosed COPD GOLD 1-2. Physical activity was evaluated using the Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) questionnaire and reported in hours per week of metabolic equivalents (MET-h/week). Associations between sociodemographic, lifestyle, clinical and functional characteristics were examined using regression analysis. 323 patients were included in research (77 with physician-diagnosed and 246 with newly diagnosed COPD). We found that physical activity was positively associated with pulmonary function: FEV1 (regression coefficient 0.40 (95% CI 0.09,0.71)) and FVC (regression coefficient 0.34 (95% CI 0.06,0.61)). Physical activity was associated with anxiety (regression coefficient =0.9 (95% CI 0.3,1.6)) only for physician-diagnosed patients. Lung function and anxiety level determine level of physical activity among COPD patients with mild or moderate airflow obstruction. Thus, integrating it into the physical activity plans could help to increase physical activity level of the patients.
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Affiliation(s)
- Amanda R van Buul
- Department of Pulmonology, Leiden University Medical Center, Leiden.
| | - Marise J Kasteleyn
- Department of Pulmonology; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden.
| | - Vitalii Poberezhets
- Department of Propedeutics of Internal Medicine, National Pirogov Memorial Medical University, Vinnytsya.
| | - Tobias N Bonten
- Department of Pulmonology; Department of Public Health and Primary Care, Leiden University Medical Center, Leiden.
| | - Renée De Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden.
| | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden.
| | - Saskia le Cessie
- Department of Clinical Epidemiology; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden.
| | - Frits R Rosendaal
- Department of Clinical Epidemiology; Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden.
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center.
| | - Christian Taube
- Department of Pulmonary Medicine, University Hospital Essen, Ruhrlandklinik, University Duisburg-Essen, Essen.
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Schapansky E, Depraetere J, Keygnaert I, Vandeviver C. Prevalence and Associated Factors of Sexual Victimization: Findings from a National Representative Sample of Belgian Adults Aged 16-69. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7360. [PMID: 34299811 PMCID: PMC8307212 DOI: 10.3390/ijerph18147360] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/27/2022]
Abstract
Sexual victimization is a major public health, judicial, and societal concern worldwide. Nationally representative and comparable studies are still lacking. We applied a broad definition of sexual violence, including hands-off and hands-on victimization, and behaviorally specific questions to assess sexual victimization. Lifetime and 12-month prevalence estimates were obtained that are representative of the Belgian general population aged 16 to 69 with regard to sex and age. These estimates indicate that 64% experienced some form of sexual victimization in their lives, and 44% experienced some form of sexual victimization in the past 12 months. Logistic regression analysis revealed significant associations for sex, age, sexual orientation, the number of sexual partners, and the financial situation with sexual victimization. Furthermore, our data show that mental health is significantly worse in persons with a history of prior sexual victimization. Prevalence estimates for all forms of sexual victimization are presented and compared to other national and international studies on sexual victimization. This comparison suggests that prevalence rates may have been underestimated in extant research. The prevalence estimates obtained in this study demonstrate that all sexes and ages are affected by sexual victimization.
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Affiliation(s)
- Evelyn Schapansky
- Department of Criminology, Criminal Law and Social Law, Ghent University, 9000 Ghent, Belgium; (E.S.); (J.D.)
| | - Joke Depraetere
- Department of Criminology, Criminal Law and Social Law, Ghent University, 9000 Ghent, Belgium; (E.S.); (J.D.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
| | - Ines Keygnaert
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium;
| | - Christophe Vandeviver
- Department of Criminology, Criminal Law and Social Law, Ghent University, 9000 Ghent, Belgium; (E.S.); (J.D.)
- Research Foundation—Flanders (FWO), 1000 Brussels, Belgium
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36
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Yang Y, Le Ray I, Zhu J, Zhang J, Hua J, Reilly M. Preeclampsia Prevalence, Risk Factors, and Pregnancy Outcomes in Sweden and China. JAMA Netw Open 2021; 4:e218401. [PMID: 33970258 PMCID: PMC8111481 DOI: 10.1001/jamanetworkopen.2021.8401] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. Within-country studies have reported racial differences in the presentation and outcome, but little is known about differences between countries. OBJECTIVE To compare preeclampsia prevalence, risk factors, and pregnancy outcomes between the Swedish and Chinese populations. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study compared deliveries from the Swedish national Medical Birth Register (2007-2012) and the China Labor and Delivery Survey (2015-2016). The Swedish Medical Birth Register records maternal, pregnancy, and neonatal information for nearly all deliveries in Sweden. The China Labor and Delivery Survey was conducted throughout China, and these data were reweighted to enable national comparisons. Participants included 555 446 deliveries from Sweden and 79 243 deliveries from China. Data management and analysis was conducted from November 2018 to August 2020 and revised in February to March 2021. EXPOSURES Maternal characteristics, parity, multiple gestation, chronic and gestational diabetes, cesarean delivery. MAIN OUTCOMES AND MEASURES Preeclampsia prevalence and risk factors, overall and for mild and severe forms and rates of adverse neonatal outcomes compared with pregnancies with no gestational hypertension. RESULTS The 555 446 Swedish pregnancies and 79 243 Chinese pregnancies had mean (SD) maternal age of 30.9 (5.3) years and 28.6 (4.6) years, respectively. The overall prevalence of preeclampsia was similar in Sweden and China, 16 068 (2.9%) and 1803 (2.3%), respectively, but with 5222 cases (32.5%) considered severe in Sweden and 1228 cases (68.1%) considered severe in China. Obesity (defined as BMI ≥28 in China and BMI ≥30 in Sweden) was a stronger risk factor in China compared with Sweden (China: odds ratio [OR], 5.12; 95% CI, 3.82-6.86; Sweden: OR, 3.49; 95% CI, 3.31-3.67). Nulliparity had a much stronger association with severe preeclampsia in Sweden compared with China (Sweden: OR, 3.91; 95% CI, 3.65-4.18; China: OR, 1.65; 95% CI, 1.20-2.25). The overall stillbirth rate for singleton in China was more than 3-fold higher than in Sweden (846/77 512[1.1%] vs 1753/547 219 [0.3%], P < .001), and 10-fold higher among women with preeclampsia (66/1652 [4.6%] vs 60/14 499[0.4%], P < .001). CONCLUSIONS AND RELEVANCE In this study, the prevalence rates of preeclampsia in Sweden and China were similar, but women in China had more severe disease and worse pregnancy outcomes than women in Sweden. The associations of obesity and nulliparity with preeclampsia suggest a role for lifestyle and health care factors but may reflect some differences in pathophysiology. These findings have relevance for current efforts to identify high-risk pregnancies and early serum markers because the value of risk prediction models and biomarkers may be population specific.
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Affiliation(s)
- Yingying Yang
- Department of Women and Children’s Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Isabelle Le Ray
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
- Department of Gynecology and Obstetrics, Strasbourg University Hospital, Strasbourg, France
| | - Jing Zhu
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Hua
- Department of Women and Children’s Health Care, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Marie Reilly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
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van Hout MJ, Dekkers IA, Westenberg JJ, Schalij MJ, Widya RL, de Mutsert R, Rosendaal FR, de Roos A, Jukema JW, Scholte AJ, Lamb HJ. Normal and reference values for cardiovascular magnetic resonance-based pulse wave velocity in the middle-aged general population. J Cardiovasc Magn Reson 2021; 23:46. [PMID: 33866975 PMCID: PMC8054386 DOI: 10.1186/s12968-021-00739-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Aortic stiffness, assessed through pulse wave velocity (PWV), is an independent predictor for cardiovascular disease risk. However, the scarce availability of normal and reference values for cardiovascular magnetic resonance imaging (CMR) based PWV is limiting clinical implementation. The aim of this study was to determine normal and reference values for CMR assessed PWV in the general population. METHODS From the 2,484 participants of the Netherlands Epidemiology of Obesity (NEO) study that have available CMR-PWV data, 1,394 participants free from cardiovasculard disease, smokers or treatment for diabetes, hypertension or dyslipidaemia were selected (45-65 years, 51% female). Participants were divided into sex, age and blood pressure (BP) subgroups. Normal values were specified for participants with a BP < 130/80 mmHg and reference values for elevated BP subgroups (≥ 130/80 and < 140/90 mmHg; and ≥ 140/90 mmHg). Differences between groups were tested with independent samples t-test or ANOVA. Due to an oversampling of obese individuals in this study, PWV values are based on a weighted analysis making them representative of the general population. RESULTS Normal mean PWV was 6.0 m/s [95% CI 5.8-6.1]. PWV increased with advancing age and BP categories (both p < 0.001). There was no difference between sex in normal PWV, however in the BP > 140/90 mmHg women had a higher PWV (p = 0.005). The interpercentile ranges were smaller for participants < 55 years old compared to participants ≥ 55 years, indicating an increasing variability of PWV with age. PWV upper limits were particularly elevated in participants ≥ 55 years old in the high blood pressure subgroups. CONCLUSION This study provides normal and reference values for CMR-assessed PWV per sex, age and blood pressure category in the general population.
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Affiliation(s)
- Max J van Hout
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Jos J Westenberg
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Ralph L Widya
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Renée de Mutsert
- Department of Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Epidemiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Zhang X, Pawlikowski M, Olivo-Marston S, Williams KP, Bower JK, Felix AS. Ten-year cardiovascular risk among cancer survivors: The National Health and Nutrition Examination Survey. PLoS One 2021; 16:e0247919. [PMID: 33661978 PMCID: PMC7932508 DOI: 10.1371/journal.pone.0247919] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/16/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cancer survivors have a higher risk of developing and dying from cardiovascular disease (CVD) compared to the general population. We sought to determine whether 10-year risk of atherosclerotic CVD (ASCVD) is elevated among those with vs. without a cancer history in a nationally representative U.S. sample. METHODS Participants aged 40-79 years with no CVD history were included from the 2007-2016 National Health and Nutrition Examination Survey. Cancer history was self-reported and 10-year risk of ASCVD was estimated using Pooled Cohort Equations. We used logistic regression to estimate associations between cancer history and odds of elevated (≥7.5%) vs. low (<7.5%) 10-year ASCVD risk. An interaction between age and cancer history was examined. RESULTS A total of 15,095 participants were included (mean age = 55.2 years) with 12.3% (n = 1,604) reporting a cancer history. Individuals with vs. without a cancer history had increased odds of elevated 10-year ASCVD risk (OR = 3.42, 95% CI: 2.51-4.66). Specifically, those with bladder/kidney, prostate, colorectal, lung, melanoma, or testicular cancer had a 2.72-10.47 higher odds of elevated 10-year ASCVD risk. Additionally, age was an effect modifier: a cancer history was associated with 1.24 (95% CI: 1.19-4.21) times higher odds of elevated 10-year ASCVD risk among those aged 60-69, but not with other age groups. CONCLUSIONS Adults with a history of self-reported cancer had higher 10-year ASCVD risk. ASCVD risk assessment and clinical surveillance of cardiovascular health following a cancer diagnosis could potentially reduce disease burden and prolong survival, especially for patients with specific cancers and high ASCVD risk.
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Affiliation(s)
- Xiaochen Zhang
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
| | - Meghan Pawlikowski
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Susan Olivo-Marston
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Karen Patricia Williams
- Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, United States of America
| | - Julie K. Bower
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
| | - Ashley S. Felix
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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Xu D, Pan J, Dai X, Hu M, Cai Y, He H, Zhang Y, Liao J, Chen Y, Gong W, Zhou Z, Zhang N, Wang X, Chan KCG, Ying X, Cai Y, Wang R, Xue Q, Yip CMW. Comparing quality of primary healthcare between public and private providers in China: study protocol of a cross-sectional study using unannounced standardised patients in seven provinces of China. BMJ Open 2021; 11:e040792. [PMID: 33436467 PMCID: PMC7805374 DOI: 10.1136/bmjopen-2020-040792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION The Chinese government has encouraged the development of private sector in delivering healthcare, including primary healthcare (PHC) in the new round of national health reform since 2009. However, the debate about the role of the private sector in achieving universal health coverage continues with poor support from theories and empirical evidence. This study intends to compare the quality of PHC services between the private and public providers in seven provinces in China, using unannounced standardised patients (USPs). METHODS We are developing and validating 13 USP cases most commonly observed in the PHC setting. Six domains of quality will be assessed by the USP: effectiveness, safety, patient centredness, efficiency, timeliness and equity. The USP will make 2200 visits to 705 public and 521 private PHC institutions across seven provinces, following a multistage clustered sample design. Using each USP-provider encounter as the analytical unit, we will first descriptively compare the raw differences in quality between the private and public providers and then analyse the association of ownership types and quality, using propensity score weighting. ETHICS AND DISSEMINATION The study was primarily funded by the National Natural Science Foundation of China (#71974211, #71874116 and # 72074163) and was also supported by the China Medical Board (#16-260, #18-300 and #18-301), and have received ethical approval from Sun Yat-sen University (#2019-024). The validated USP tool and the data collected in this study will be freely available for the public after the primary analysis of the study. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry: #ChiCTR2000032773.
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Affiliation(s)
- Dong Xu
- ACACIA Lab for Health Systems Strengthening and Department of Health Management, School of Health Management, Southern Medical University, Guangzhou, China
| | - Jay Pan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Xiaochen Dai
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Mengyao Hu
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Yiyuan Cai
- School of Public Health, Guizhou Medical University, Guiyang, China
| | - Hua He
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Yaoguang Zhang
- Center for Health Statistics and Information, National Health Commission, Beijing, China
| | - Jing Liao
- Sun Yat-sen Global Health Institute, Sun Yat-sen University, Guangzhou, China
- Medicial statistics and epidemiology School of public health, Sun Yat-sen university, Guangzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, China
| | - Wenjie Gong
- School of Public Health, Central South University, Changsha, China
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Nan Zhang
- Department of Health Management, School of Health Management, Inner Mongolia Medical University, Hohhot, China
| | - Xiaohui Wang
- School of Public Health, Lanzhou University, Lanzhou, China
| | | | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
| | - Yue Cai
- Center for Health Statistics and Information, National Health Commission, Beijing, China
| | - Ruixin Wang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qingping Xue
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- School of Public Health, Chengdu Medical College, Chengdu, China
| | - Chi-Man Winnie Yip
- Department of Global Health and Population, Harvard University, Cambridge, Massachusetts, USA
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Cavalcante DDFB, Pereira AC, Araújo ECFD, Cavalcanti YW, Meneghim MDC, Ambrosano GMB. Impact of Non-Weighting in the Analysis of Data Obtained from Complex Samples. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Colabianchi N, Antonakos CL, Coulton CJ, Kaestner R, Lauria M, Porter DE. The role of the built environment, food prices and neighborhood poverty in fruit and vegetable consumption: An instrumental variable analysis of the moving to opportunity experiment. Health Place 2021; 67:102491. [PMID: 33348282 PMCID: PMC8123939 DOI: 10.1016/j.healthplace.2020.102491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/17/2020] [Accepted: 11/12/2020] [Indexed: 10/22/2022]
Abstract
The food environment has been associated with fruit and vegetable consumption, however many studies utilize cross-sectional research designs. This study examined 3,473 participants in the Moving to Opportunity experiment, who were randomized into groups that affected where they lived. The relationship between the built environment, food prices and neighborhood poverty, assessed over four to seven years, on fruit or vegetable consumption was examined using instrumental variable analysis. Higher food prices and neighborhood poverty were associated with lower fruit or vegetable consumption. Policies and programs that address food prices should be implemented and evaluated for their effects on fruit and vegetable consumption.
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Affiliation(s)
| | - Cathy L Antonakos
- 1402 Washington Heights, Ann Arbor, MI, 48109, University of Michigan, USA.
| | - Claudia J Coulton
- 11402 Bellflower Road, Cleveland, OH, 44106-7167, Case Western Reserve University, USA.
| | - Robert Kaestner
- 1307 East 60th Street, University of Chicago, Chicago, IL, 60637, USA.
| | - Mickey Lauria
- 323 Fernow St, Clemson University, Clemson, SC, 29634, USA.
| | - Dwayne E Porter
- 915 Greene Street, University of South Carolina, Columbia, SC, 29201, USA.
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Luo K, Aimuzi R, Wang Y, Nian M, Zhang J. Urinary organophosphate esters metabolites, glucose homeostasis and prediabetes in adolescents. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 267:115607. [PMID: 33254666 DOI: 10.1016/j.envpol.2020.115607] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/17/2020] [Accepted: 09/03/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Emerging experimental evidence indicates that organophosphate esters (OPEs) can trigger glucose metabolic disorders. However, human evidence, especially in adolescents, is unavailable. OBJECTIVES We utilized data from the National Health and Nutrition Examination Survey 2011-2014 to evaluate whether urinary OPEs metabolites were associated with prediabetes and glucose homeostasis. METHODS A total of 349 adolescents (12-19-year old) who provided at least 8 h fasting blood samples, had urinary OPEs metabolites detected were included. Prediabetes was defined according to the levels of fasting plasma glucose (FPG), 2-h post oral plasma glucose (2 h-OGTT) and glycated hemoglobin A1c (HbA1c). The homeostatic model assessment (HOMA-IR) and the Single Point Insulin Sensitivity Estimator (SPISE) were used to assess insulin resistance and sensitivity, respectively. Multiple binary logistic and linear regressions were used to evaluate the associations with prediabetes and indices of glucose homeostasis. The least absolute shrinkage and selection operator (LASSO) regression was used to assess the associations in a multi-pollutant context. RESULTS After adjusting for covariates, certain urinary OPEs metabolites were associated with prediabetes and indices of glucose homeostasis in all adolescents. Stratified analyses by sex revealed that such associations were largely sex-dependent. In females, the multiple pollutant models showed that bis(1,3-32 dichloro-2-propyl) phosphate (BDCIPP) was positively associated with prediabetes [odds ratio (OR) = 2.51, 95%CI:1.29, 4.89, for one scaled unit increase in exposure] and 2 h-OGTT (β = 0.07, 95%CI:0.01,0.12); bis(2-chloroethyl) phosphate (BCEP) was negatively associated with fasting insulin (β = -0.10, 95%CI: 0.19,-0.01) and HOMA-IR (β = -0.10, 95%CI: 0.19,-0.003); and detectable bis(1-choloro-2-propyl) phosphate (BCIPP) (>LOD vs < LOD) was inversely associated with 2 h-OGTT (β = -0.11, 95%CI: 0.21,-0.02). In males, consistent inverse associations were found for detectable di-n-butyl phosphate (DNBP) with prediabetes, FPG, 2 h-OGTT, fasting insulin and HOMA-IR. CONCLUSION Urinary OPEs metabolites were associated with prediabetes and indices of glucose homeostasis in adolescents. But such associations varied by sex. Future studies with multiple measurements of OPEs exposure are needed to confirm our findings.
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Affiliation(s)
- Kai Luo
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Ruxianguli Aimuzi
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Yuqing Wang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Min Nian
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China; School of Public Health, Shanghai Jiao Tong University, Shanghai, 200025, China.
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Eveleens Maarse BC, Loh NY, Karpe F, Rosendaal FR, van Heemst D, Mook-Kanamori DO, Willems van Dijk K, Rensen PCN, Kooijman S, Christodoulides C, Noordam R. Associations between outdoor temperature and bright sunlight with metabolites in two population-based European cohorts. Nutr Metab Cardiovasc Dis 2020; 30:2252-2261. [PMID: 32912789 DOI: 10.1016/j.numecd.2020.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Outdoor temperature and bright sunlight may directly and/or indirectly modulate systemic metabolism. We assessed the associations between outdoor temperature and bright sunlight duration with metabolomics. METHODS AND RESULTS Cross-sectional analyses were undertaken in non-diabetic individuals from the Oxford BioBank (OBB; N = 6368; mean age 47.0 years, males 44%) and the Netherlands Epidemiology of Obesity (NEO; N = 5916; mean age 55.6 years, males 43%) study. Data on mean outdoor bright sunlight and temperature were collected from local weather stations in the week prior to blood sampling. Fasting serum levels of 148 metabolites, including 14 lipoprotein subclasses, were measured using NMR spectroscopy. Linear regression analyses were performed to assess the associations between mean outdoor temperature and bright sunlight duration with metabolomics adjusted for age, sex, body mass index, season and either outdoor temperature or bright sunlight. A higher mean outdoor temperature was associated with increased serum concentrations of lipoprotein (sub)particles (β (SE) = 0.064 (0.018) SD per 5 °C, p = 5.03e-4) and certain amino acids such as phenylalanine (0.066 (0.016) SD, p = 6.44e-05) and leucine (0.111 (0.018) SD, p = 1.25e-09). In contrast, longer duration of bright sunlight was specifically associated with lower concentrations of very low-density lipoprotein (sub)particles (e.g., VLDL cholesterol (-0.024 (0.005) SD per 1-h bright sunlight, p = 8.06e-6)). The direction of effects was generally consistent between the OBB and NEO, although effect sizes were generally larger in the OBB. CONCLUSIONS Increased bright sunlight duration is associated with an improved metabolic profile whilst higher outdoor temperature may adversely impact cardiometabolic health.
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Affiliation(s)
- Boukje C Eveleens Maarse
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nellie Y Loh
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Fredrik Karpe
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; NIHR Oxford Biomedical Research Centre, OUH Foundation Trust, Oxford, UK
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Dennis O Mook-Kanamori
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ko Willems van Dijk
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Patrick C N Rensen
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Sander Kooijman
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands; Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Constantinos Christodoulides
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
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Morelli VM, de Mutsert R, de Roos A, Lamb HJ, van Hylckama Vlieg A, Bos MHA, Rosendaal FR, Lijfering WM, Cannegieter SC. Association Between Hepatic Triglyceride Content and Coagulation Factors: The Netherlands Epidemiology of Obesity Study. Arterioscler Thromb Vasc Biol 2020; 40:3004-3014. [PMID: 33115270 DOI: 10.1161/atvbaha.120.315365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Whether hepatic triglyceride content (HTGC) contributes to hypercoagulability beyond total body fat (TBF) and visceral adipose tissue (VAT) is unclear. We, therefore, aimed to investigate the association between HTGC and coagulation factors (F)I (fibrinogen), VIII, IX, and XI while adjusting for TBF and VAT. Approach and Results: In this cross-sectional analysis of the NEO study (Netherlands Epidemiology of Obesity; n=6671), a random subset of participants underwent magnetic resonance imaging and magnetic resonance spectroscopy to assess VAT and HTGC (n=2580). We excluded participants without complete imaging and coagulation assessment, and with history of liver disease, venous thrombosis, or on anticoagulation. Mean differences in coagulation factor levels across HTGC quartiles were estimated by linear regression adjusted for age, sex, ethnicity, education, alcohol intake, physical activity, smoking, estrogen, and menopause, in addition to TBF and VAT. Among the 1946 participants included, median HTGC was 2.66% (interquartile range: 1.34%-6.27%). Coagulation factor levels increased dose-dependently across HTGC quartiles. Mean differences between the fourth and first quartiles were 14.7 mg/dL (95% CI, 2.1-27.2) for fibrinogen, 6.7 IU/dL (95% CI, 0.5-12.9) for FVIII, 26.1 IU/dL (95% CI, 22.4-29.8) for FIX, and 8.6 IU/dL (95% CI, 4.6-12.6) for FXI. With further adjustment for TBF and VAT, the dose-response association of HTGC with FIX persisted, whereas associations with other factors disappeared. CONCLUSIONS HTGC was associated with various coagulation factors, of which FIX remained associated with HTGC after adjustment for TBF and VAT. HTGC might contribute to venous thrombosis risk beyond total body and visceral fat through FIX levels.
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Affiliation(s)
- Vânia M Morelli
- K.G. Jebsen Thrombosis Research and Expertise Center (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø (V.M.M.).,Department of Clinical Epidemiology (V.M.M., R.d.M., A.v.H.V., F.R.R., W.M.L., S.C.C.), Leiden University Medical Center, Leiden, The Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology (V.M.M., R.d.M., A.v.H.V., F.R.R., W.M.L., S.C.C.), Leiden University Medical Center, Leiden, The Netherlands
| | - Albert de Roos
- Department of Radiology (A.d.R., H.J.L.), Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology (A.d.R., H.J.L.), Leiden University Medical Center, Leiden, The Netherlands
| | - Astrid van Hylckama Vlieg
- Department of Clinical Epidemiology (V.M.M., R.d.M., A.v.H.V., F.R.R., W.M.L., S.C.C.), Leiden University Medical Center, Leiden, The Netherlands
| | - Mettine H A Bos
- Department of Internal Medicine, Section of Thrombosis and Hemostasis (M.H.A.B., S.C.C.), Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology (V.M.M., R.d.M., A.v.H.V., F.R.R., W.M.L., S.C.C.), Leiden University Medical Center, Leiden, The Netherlands
| | - Willem M Lijfering
- Department of Clinical Epidemiology (V.M.M., R.d.M., A.v.H.V., F.R.R., W.M.L., S.C.C.), Leiden University Medical Center, Leiden, The Netherlands
| | - Suzanne C Cannegieter
- Department of Clinical Epidemiology (V.M.M., R.d.M., A.v.H.V., F.R.R., W.M.L., S.C.C.), Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, Section of Thrombosis and Hemostasis (M.H.A.B., S.C.C.), Leiden University Medical Center, Leiden, The Netherlands
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Guth M, Pollock T, Fisher M, Arbuckle TE, Bouchard MF. Concentrations of urinary parabens and reproductive hormones in girls 6-17 years living in Canada. Int J Hyg Environ Health 2020; 231:113633. [PMID: 33045491 DOI: 10.1016/j.ijheh.2020.113633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Parabens are chemical substances used as preservatives for their antibacterial and antifungal properties in many personal care products, and sometimes in pharmaceutical and food products. Concerns for adverse human health effects arise from animal studies showing endocrine disrupting effects, such as changes in the timing of puberty and alterations in reproductive hormone activity. Our objective was to examine the association between urinary concentrations of parabens and serum concentrations of estradiol, progesterone, follicle stimulating hormone [FSH], and luteinizing hormone [LH]) in girls from the general population. METHODS We conducted a cross-sectional study in girls ages 6-17 years, using data from the Canadian Health Measures Survey (2014-2015). The association between concentrations of creatinine-standardized urinary parabens and serum hormone concentrations was analyzed with multivariable linear regressions, adjusting for potential confounders (i.e., age, body mass index, ethnicity, household income, sampling season; prenatal exposure to cigarette smoke for girls 6-11 years). RESULTS The 382 girls and teens included in the study had a mean age of 11.0 years; 76% were white and 73% had a body mass index in the range normal/underweight. Most participants (92%) had least one paraben detected in their urine. Girls with higher urinary paraben concentrations had significantly lower serum concentrations of estradiol, LH, and FSH, but not of progesterone. A doubling in the sum of urinary parabens was associated with 5.8% lower estradiol (95% CI -9.3, -2.1), 4.2% lower FSH (95% CI -7.9, -0.3), and 10.8% lower LH (95% CI -17.4, -3.7). The analysis of individual compounds showed that all four parabens were similarly associated with lower concentrations of estradiol, FSH, and LH. We further analyzed younger girls (6-11 years) and found that urinary parabens were similarly associated with lower estradiol and LH (doubling in the sum of parabens associated with 5.9% lower estradiol [95% CI -10.5, -1.0] and 10.9% lower LH [95% CI -20.2, -0.6]). In this younger subgroup, the association estimate for FSH, however, was attenuated and no longer statistically significant. DISCUSSION We observed that exposure to parabens was associated with reduced concentrations of circulating reproductive hormones, suggesting that these chemicals could alter the development and function of the endocrine system in girls. Further prospective research using long-term assessment of parabens exposure and of reproductive development may better determine endocrine disrupting effects of parabens.
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Affiliation(s)
- Margot Guth
- Department of Environmental and Occupational Health, School of Public Health, Universite de Montreal, Montreal, Quebec, Canada
| | - Tyler Pollock
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Mandy Fisher
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Tye E Arbuckle
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Maryse F Bouchard
- Department of Environmental and Occupational Health, School of Public Health, Universite de Montreal, Montreal, Quebec, Canada; CHU Sainte-Justine Research Centre Mother and Child University Hospital Center, Canada.
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Lee YM, Shin JY, Kim SA, Jacobs DR, Lee DH. Can Habitual Exercise Help Reduce Serum Concentrations of Lipophilic Chemical Mixtures? Association between Physical Activity and Persistent Organic Pollutants. Diabetes Metab J 2020; 44:764-774. [PMID: 32174058 PMCID: PMC7643589 DOI: 10.4093/dmj.2019.0158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/20/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Low-dose persistent organic pollutants (POPs), especially organochlorine pesticides (OCPs), have emerged as a new risk factor of many chronic diseases. As serum concentrations of POPs in humans are mainly determined by both their release from adipose tissue to circulation and their elimination from circulation, management of these internal pathways may be important in controlling the serum concentrations of POPs. As habitual physical activity can increase the elimination of POPs from circulation, we evaluated whether chronic physical activity is related to low serum POP concentrations. METHODS A cross-sectional study of 1,850 healthy adults (age ≥20 years) without cardio-metabolic diseases who participated in the U.S. National Health and Nutrition Examination Survey 1999 to 2004 was conducted. Information on moderate or vigorous leisure-time physical activity was obtained based on questionnaires. Serum concentrations of OCPs and polychlorinated biphenyls were investigated as typical POPs. RESULTS Serum concentrations of OCPs among physically active subjects were significantly lower than those among physically inactive subjects (312.8 ng/g lipid vs. 538.0 ng/g lipid, P<0.001). This difference was maintained after adjustment for potential confounders. When analyses were restricted to physically active subjects, there were small decreases in the serum concentrations of OCPs with increasing duration of physical activity, showing a curvilinear relationship over the whole range of physical activity (Pquadratic <0.001). In analyses stratified by age, sex, body mass index, and smoking status, a strong inverse association was similarly observed among all subgroups. CONCLUSION Physical activity may assist in decreasing serum concentrations of lipophilic chemical mixtures such as OCPs.
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Affiliation(s)
- Yu-Mi Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Se-A Kim
- Department of Biomedical Science, Graduate School, Kyungpook National University, Daegu, Korea
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Korea
| | - David R. Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Duk-Hee Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
- Department of Biomedical Science, Graduate School, Kyungpook National University, Daegu, Korea
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Korea
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Oh S, DiNitto DM, Powers DA. A longitudinal evaluation of government-sponsored job skills training and basic employment services among U.S. baby boomers with economic disadvantages. EVALUATION AND PROGRAM PLANNING 2020; 82:101845. [PMID: 32623184 PMCID: PMC10372812 DOI: 10.1016/j.evalprogplan.2020.101845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/20/2020] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
Job skills training is a cost-effective strategy for improving employment among individuals who have low income and employment barriers, but few U.S. government-sponsored employment program participants have received such training. To better understand long-term gains from job skills training, this study compared employment and earnings trajectories between program participants who received job skills training and those who received basic services only. Using data from the National Longitudinal Survey of Youth 1979, we estimated 33-year employment and earnings trajectories among U.S. baby-boomer cohorts while accounting for baseline group heterogeneity using inverse propensity score weighting. We found increases in employment rates over the life course, especially among Black women. Job skills training also increased earnings by up to 69.6 % compared to basic services only. Despite the long-term gains in employment and earnings, job skills training participation is not sufficient to address gender as well as racial and ethnic gaps in full-time employment. Findings reinforce the importance of incorporating job skills training as an essential service element of government-sponsored employment programs to improve long-term labor market outcomes among Americans with economic disadvantages.
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Affiliation(s)
- Sehun Oh
- College of Social Work, The Ohio State University, Columbus, OH, 43210, United States.
| | - Diana M DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, 78712, United States
| | - Daniel A Powers
- Department of Sociology, The University of Texas at Austin, Austin, TX, 78712, United States
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Perin J, Koffi AK, Kalter HD, Monehin J, Adewemimo A, Quinley J, Black RE. Using propensity scores to estimate the effectiveness of maternal and newborn interventions to reduce neonatal mortality in Nigeria. BMC Pregnancy Childbirth 2020; 20:534. [PMID: 32928142 PMCID: PMC7488987 DOI: 10.1186/s12884-020-03220-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/28/2020] [Indexed: 11/11/2022] Open
Abstract
Background Nigeria is the largest country in sub-Saharan Africa, with one of the highest neonatal mortality rates and the second highest number of neonatal deaths in the world. There is broad international consensus on which interventions can most effectively reduce neonatal mortality, however, there is little direct evidence on what interventions are effective in the Nigerian setting. Methods We used the 2013 Nigeria Demographic and Health Survey (NDHS) and the follow-up 2014 Verbal and Social Autopsy study of neonatal deaths to estimate the association between neonatal survival and mothers’ and neonates’ receipt of 18 resources and interventions along the continuum of care with information available in the NDHS. We formed propensity scores to predict the probability of receiving the intervention or resource and then weighted the observations by the inverse of the propensity score to estimate the association with mortality. We examined all-cause mortality as well as mortality due to infectious causes and intrapartum related events. Results Among 19,685 livebirths and 538 neonatal deaths, we achieved adequate balance for population characteristics and maternal and neonatal health care received for 10 of 18 resources and interventions, although inference for most antenatal interventions was not possible. Of ten resources and interventions that met our criteria for balance of potential confounders, only early breastfeeding was related to decreased all-cause neonatal mortality (relative risk 0.42, 95% CI 0.32–0.52, p < 0.001). Maternal decision making and postnatal health care reduced mortality due to infectious causes, with relative risks of 0.29 (95% CI 0.09–0.88; 0.030) and 0.46 (0.22–0.95; 0.037), respectively. Early breastfeeding and delayed bathing were related to decreased mortality due to intrapartum events, although these are not likely to be causal associations. Conclusion Access to immediate postnatal care and women’s autonomous decision-making have been among the most effective interventions for reducing neonatal mortality in Nigeria. As neonatal mortality increases relative to overall child mortality, accessible interventions are necessary to make further progress for neonatal survival in Nigeria and other low resource settings.
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Affiliation(s)
- Jamie Perin
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. .,Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Alain K Koffi
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Henry D Kalter
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Wong SW, Buu A, Lin HC. State Medical Marijuana Laws and Associated Marijuana Use, Attitudes, and Perceived Social Norms among Adolescents in the U.S. J Psychoactive Drugs 2020; 52:383-392. [PMID: 32723036 DOI: 10.1080/02791072.2020.1795325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Statewide medical marijuana laws (MMLs) in the U.S. may be associated with adolescent marijuana use behavior, attitudes toward marijuana use, and social norms. This study used data from the National Study on Drug Use and Health (2013-2016) to examine the associations of state MML with marijuana use, use frequency, and attitudes and perceived peer and parental social norms toward using marijuana. Propensity-score matching was used to reduce selection bias between states with and without MML (matched N = 50,000). Results showed that adolescents residing in states with MML had higher odds of using marijuana in the past month and past year (OR = 1.45 and 1.49; ps < .001), higher marijuana use frequencies in the past month (β = 0.12, p < .001), relatively more neutral attitudes toward marijuana use (β = - 0.06, p < .001), and weaker perception of peer and parental disapproval of marijuana use (β = - 0.04 and -0.02, ps < .001). Our findings suggested that for the states that have implemented MML, special efforts should be strengthened to prevent and reduce adolescent marijuana use. For the states that have not yet implemented MML, the associations between MML and adolescent marijuana use attitudes and perceived norms should be taken into account when legislating medical marijuana and designing prevention and intervention efforts.
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Affiliation(s)
- Su-Wei Wong
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston , Houston, TX, USA
| | - Anne Buu
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston , Houston, TX, USA
| | - Hsien-Chang Lin
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington , Bloomington, IN, USA
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Noordam R, Boersma V, Verkouter I, le Cessie S, Christen T, Lamb HJ, Rosendaal FR, Willems van Dijk K, van Heemst D, de Mutsert R. The role of C-reactive protein, adiponectin and leptin in the association between abdominal adiposity and insulin resistance in middle-aged individuals. Nutr Metab Cardiovasc Dis 2020; 30:1306-1314. [PMID: 32507340 DOI: 10.1016/j.numecd.2020.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS In the present study, we assessed the extent of mediation by low-grade systemic inflammation and adipokines in the association between abdominal adiposity and insulin resistance. METHODS AND RESULTS In this cross-sectional analysis of baseline measurements of the Netherlands Epidemiology of Obesity study, total body fat (TBF) was measured in all (n = 5772) participants who did not have missing data and neither used glucose-lowering medication, and abdominal subcutaneous adipose tissue (aSAT) and visceral adipose tissue (VAT) were assessed by MRI in a random subgroup (n = 2448). C-reactive protein (CRP), adiponectin, and leptin were considered as potential mediators, and insulin resistance was assessed by Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). Mediation by CRP, adiponectin, and leptin was studied by including the mediators to the fully adjusted linear regression model. Participants had a mean (SD) age of 56 (6) years, TBF of 36 (9) %, VAT of 119 (61) cm2 and aSAT of 300 (111) cm2. Per SD of TBF, VAT and aSAT, HOMA-IR was 64% (95% confidence interval [CI]: 59-70), 33% (95%CI: 28-42) and 20% (95%CI: 14-26) higher, respectively. The association between aSAT and HOMA-IR fully disappeared after adjustment for leptin; the association between VAT and HOMA-IR attenuated after adjustment for leptin (22%) and adiponectin (15%). No mediation was observed by CRP, and mediation estimates were similar in men and women. CONCLUSION Where leptin fully explained the aSAT-HOMA-IR association, the VAT-HOMA-IR association was only partly explained by leptin and adiponectin similarly in men and women.
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Affiliation(s)
- Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Vesna Boersma
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Inge Verkouter
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Saskia le Cessie
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Biomedical Datasciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Tim Christen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ko Willems van Dijk
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands; Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Diana van Heemst
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Renée de Mutsert
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
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